Provider Demographics
NPI:1275645327
Name:MOLYNEAUX, CRAIG W (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:MOLYNEAUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E ELMS RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2810
Mailing Address - Country:US
Mailing Address - Phone:254-519-4700
Mailing Address - Fax:254-519-7649
Practice Address - Street 1:1405 E ELMS RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2810
Practice Address - Country:US
Practice Address - Phone:254-519-4700
Practice Address - Fax:254-519-7649
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX803485OtherUNITED CONCORDIA INS