Provider Demographics
NPI:1649480310
Name:ANDREW J MOLAK DMD
Entity type:Organization
Organization Name:ANDREW J MOLAK DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-336-4525
Mailing Address - Street 1:659 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5620
Mailing Address - Country:US
Mailing Address - Phone:508-336-4525
Mailing Address - Fax:
Practice Address - Street 1:659 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5620
Practice Address - Country:US
Practice Address - Phone:508-336-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11972Other1
RI8878-1Other2