Provider Demographics
NPI:1639967987
Name:CORNELIUS, MOLLY (DDS)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:CORNELIUS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-2813
Mailing Address - Country:US
Mailing Address - Phone:308-530-8690
Mailing Address - Fax:
Practice Address - Street 1:3423 S 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3573
Practice Address - Country:US
Practice Address - Phone:402-341-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist