Provider Demographics
NPI:1790520518
Name:DR. LULU MOLINA PEDIATRIC DENTIST
Entity type:Organization
Organization Name:DR. LULU MOLINA PEDIATRIC DENTIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:DE L
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-336-8545
Mailing Address - Street 1:9002 E DESERT COVE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6275
Mailing Address - Country:US
Mailing Address - Phone:877-494-4459
Mailing Address - Fax:
Practice Address - Street 1:9002 E DESERT COVE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6275
Practice Address - Country:US
Practice Address - Phone:877-494-4459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty