Provider Demographics
NPI:1841424025
Name:MOLOCK-SMITH, IMANI NIA (DDS)
Entity type:Individual
Prefix:DR
First Name:IMANI
Middle Name:NIA
Last Name:MOLOCK-SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 OAK ST
Mailing Address - Street 2:APT 4211
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2483
Mailing Address - Country:US
Mailing Address - Phone:215-620-1342
Mailing Address - Fax:
Practice Address - Street 1:98 OAK ST
Practice Address - Street 2:APT 4211
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2483
Practice Address - Country:US
Practice Address - Phone:215-620-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037815122300000X
NJ22DI02407600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist