Basic Information
| Provider Information | |||||||||
| NPI: | 1063437853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOLNAR | ||||||||
| FirstName: | GEORGETTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S. CENTRAL VALLEY HWY | ||||||||
| Address2: | P.O. BOX 1060 | ||||||||
| City: | SHAFTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932631060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614591900 | ||||||||
| FaxNumber: | 6614591974 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 7TH ST | ||||||||
| Address2: | |||||||||
| City: | WASCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617585903 | ||||||||
| FaxNumber: | 6617586630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | A3352807 | CA | N | Dental Providers | Dentist | 122300000X | 47027 | CA | Y | Dental Providers | Dentist |
No ID Information.