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General NPI Number Information
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NPI Number | 1730107707
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Entity Type | Organization
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Legal Business Name | GUILLERMO J. MOLINA, DDS & ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 E RIDGEWOOD AVE EAST WING, FIRST FLOOR
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3957
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Country | US
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Telephone | 201-670-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E RIDGEWOOD AVE EAST WING, FIRST FLOOR
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3957
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Country | US
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Telephone | 201-670-7774
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUILLERMO J MOLINA
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Credential | DDS
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Telephone | 201-670-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 22DI01892300
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License Number State | NJ
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