Healthcare Provider Details

I. General information

NPI: 1063437853
Provider Name (Legal Business Name): GEORGETTA MOLNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 7TH ST
WASCO CA
93280
US

IV. Provider business mailing address

659 S. CENTRAL VALLEY HWY P.O. BOX 1060
SHAFTER CA
93263-1060
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-5903
  • Fax: 661-758-6630
Mailing address:
  • Phone: 661-459-1900
  • Fax: 661-459-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberA3352807
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: