Provider Demographics
NPI:1184801789
Name:DR. JEANNIE ANN MOLATO D.M.D.
Entity type:Organization
Organization Name:DR. JEANNIE ANN MOLATO D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOLATO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-988-8184
Mailing Address - Street 1:7133 SEPULVEDA BLVD.
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405
Mailing Address - Country:US
Mailing Address - Phone:818-988-8184
Mailing Address - Fax:818-988-8727
Practice Address - Street 1:7133 SEPULVEDA BLVD.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-988-8184
Practice Address - Fax:818-988-8727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480541223G0001X
CA44948261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44948OtherDENTAL LICENSE
CAB44948-O1OtherDENTI-CAL
CA319275608OtherADA #
CA319275608OtherADA #