Healthcare Provider Details

I. General information

NPI: 1134279987
Provider Name (Legal Business Name): MOLLY MCCARTY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W TOWN PL STE 106
ST AUGUSTINE FL
32092-3662
US

IV. Provider business mailing address

425 W TOWN PL STE 106
ST AUGUSTINE FL
32092-3662
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-7994
  • Fax:
Mailing address:
  • Phone: 904-940-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN16573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: