Healthcare Provider Details

I. General information

NPI: 1801026273
Provider Name (Legal Business Name): TITO MOLINA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 REED AVE
LEXINGTON SC
29072
US

IV. Provider business mailing address

23226 WILLOW CANYON DR
KATY TX
77494-3526
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-6113
  • Fax: 803-957-5290
Mailing address:
  • Phone: 310-213-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25516
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58476
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11313
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: