Healthcare Provider Details

I. General information

NPI: 1194864884
Provider Name (Legal Business Name): LUZ MOLINA D.M.D,M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 E PINNACLE PEAK RD STE G5-454
SCOTTSDALE AZ
85255-3618
US

IV. Provider business mailing address

8924 E PINNACLE PEAK RD STE G5-454
SCOTTSDALE AZ
85255-3618
US

V. Phone/Fax

Practice location:
  • Phone: 775-336-8545
  • Fax:
Mailing address:
  • Phone: 775-336-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2986
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD011584
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: