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General NPI Number Information
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NPI Number | 1336660752
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Entity Type | Individual
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Provider Name | MEGHAN MARIE MOLINA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 8300 BOONE BLVD STE 140
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City | VIENNA
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State | VA
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Zip | 22182-2626
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Country | US
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Telephone | 703-714-7374
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Fax |
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Provider Business Mailing Address
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Address Line | 25767 TULLOW PL
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City | SOUTH RIDING
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State | VA
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Zip | 20152-2572
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Country | US
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Telephone |
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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 | 4551
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401415620
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License Number State | VA
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