Healthcare Provider Details

I. General information

NPI: 1568671626
Provider Name (Legal Business Name): ANDRE MOL DDS, MS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRAUER HALL CB # 7450
CHAPEL HILL NC
27599-7450
US

IV. Provider business mailing address

110 MEETING ST
CHAPEL HILL NC
27516-9168
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number0037
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number047561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: