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General NPI Number Information
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NPI Number | 1417519638
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Entity Type | Individual
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Provider Name | MARIA MOLNAR
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 6300 GRAND AVE
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City | GURNEE
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State | IL
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Zip | 60031-4538
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Country | US
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Telephone | 224-214-4902
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 W FARWELL AVE
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City | CHICAGO
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State | IL
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Zip | 60626-3819
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Country | US
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Telephone | 773-886-9736
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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 | 019.032185
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License Number State | IL
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