Healthcare Provider Details

I. General information

NPI: 1659379121
Provider Name (Legal Business Name): DANTE C. MOLINO CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVENUE A
SWOYERSVILLE PA
18704-1911
US

IV. Provider business mailing address

300 AVENUE A
SWOYERSVILLE PA
18704-1911
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-3835
  • Fax: 579-283-3805
Mailing address:
  • Phone: 570-283-3835
  • Fax: 579-283-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: