Provider Demographics
NPI:1700912284
Name:MOLBY, ERIK NELSON (DMD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:NELSON
Last Name:MOLBY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2004
Mailing Address - Country:US
Mailing Address - Phone:231-499-3156
Mailing Address - Fax:
Practice Address - Street 1:421 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2004
Practice Address - Country:US
Practice Address - Phone:231-922-0775
Practice Address - Fax:231-941-1831
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice