Healthcare Provider Details

I. General information

NPI: 1790752350
Provider Name (Legal Business Name): KENNETH J. MOLNAR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 PARK AVE W
MANSFIELD OH
44906-1226
US

IV. Provider business mailing address

2191 PARK AVE W
MANSFIELD OH
44906-1226
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-9494
  • Fax: 419-529-9391
Mailing address:
  • Phone: 419-529-9494
  • Fax: 419-529-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30017611
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: