Healthcare Provider Details

I. General information

NPI: 1447224035
Provider Name (Legal Business Name): MAX H MOLGARD JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 N CEDAR RD SUITE 102
SPOKANE WA
99208-4277
US

IV. Provider business mailing address

6817 N CEDAR RD SUITE 102
SPOKANE WA
99208-4277
US

V. Phone/Fax

Practice location:
  • Phone: 509-327-4469
  • Fax: 509-328-9902
Mailing address:
  • Phone: 509-327-4469
  • Fax: 509-328-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE60547038
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: