MEDICARE: MR. MICHAEL E MOLONY DMD PSC

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	122300000X	Dentist	4458	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	501030	OTHER	KY	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194888099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL E MOLONY DMD PSC

Provider Business Mailing Address
First Line	:	2220 GRANDVIEW DRIVE
Second Line	:	SUITE 240
City	:	FT MITCHELL
State	:	KY
Zip	:	41017
Country	:	US
Telephone Number	:	859-344-0400
Fax Number	:	859-344-8980

Provider Business Practice Location Address
First Line	:	2220 GRANDVIEW DRIVE
Second Line	:	SUITE 240
City	:	FT MITCHELL
State	:	KY
Zip	:	41017
Country	:	US
Telephone Number	:	859-344-0400
Fax Number	:	859-344-8980

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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