MEDICARE: MOLLY BREMEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DDS-09177	IA

General Provider Information

NPI Number	:	1043507890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY BREMEN DDS

Provider Business Mailing Address
First Line	:	7600 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-3111
Country	:	US
Telephone Number	:	515-650-4441
Fax Number	:	515-630-1916

Provider Business Practice Location Address
First Line	:	7600 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-3111
Country	:	US
Telephone Number	:	515-650-4441
Fax Number	:	515-630-1916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	03/02/2020

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Directions to “ MOLLY BREMEN DDS” Practice Location

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