Healthcare Provider Details

I. General information

NPI: 1285000505
Provider Name (Legal Business Name): CHRISTINE MOLESKI, DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 LEE SMITH DR
JUNEAU AK
99801-8017
US

IV. Provider business mailing address

9191 LEE SMITH DR
JUNEAU AK
99801-8017
US

V. Phone/Fax

Practice location:
  • Phone: 907-789-0131
  • Fax: 907-789-7110
Mailing address:
  • Phone: 907-789-0131
  • Fax: 907-789-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE MICHELLE MOLESKI
Title or Position: OWNER/DOCTOR
Credential: DMD
Phone: 907-789-0131