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General NPI Number Information
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NPI Number | 1154792968
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Entity Type | Individual
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Provider Name | JOSE EDUARDO MOLINA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 5492 N PALM AVE
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City | FRESNO
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State | CA
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Zip | 93704-1959
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Country | US
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Telephone | 559-435-3113
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Fax | 559-435-5785
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Provider Business Mailing Address
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Address Line | 6303 W THOMPSON AVE
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City | VISALIA
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State | CA
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Zip | 93291-9784
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Country | US
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Telephone | 559-346-8031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 64712
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License Number State | CA
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