Healthcare Provider Details

I. General information

NPI: 1346979556
Provider Name (Legal Business Name): HAILEY MARIE MOLINA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6574 S KANNER HWY
STUART FL
34997-6396
US

IV. Provider business mailing address

6574 S KANNER HWY
STUART FL
34997-6396
US

V. Phone/Fax

Practice location:
  • Phone: 772-324-7824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: