Provider Demographics
NPI:1376746628
Name:MOLEN, KENNETH ALVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALVIN
Last Name:MOLEN
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 1:1176 S 1480 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-4905
Mailing Address - Country:US
Mailing Address - Phone:801-426-8234
Mailing Address - Fax:801-224-5437
Practice Address - Street 1:1176 S 1480 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-4905
Practice Address - Country:US
Practice Address - Phone:801-426-8234
Practice Address - Fax:801-224-5437
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice