MEDICARE: CHRISTINE MOLESKI, DMD, P.C.

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	1223G0001X	General Practice Dentistry
2	122300000X	Dentist

General Provider Information

NPI Number	:	1285000505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTINE MOLESKI, DMD, P.C.

Provider Business Mailing Address
First Line	:	9191 LEE SMITH DR
Second Line	:
City	:	JUNEAU
State	:	AK
Zip	:	99801-8017
Country	:	US
Telephone Number	:	907-789-0131
Fax Number	:	907-789-7110

Provider Business Practice Location Address
First Line	:	9191 LEE SMITH DR
Second Line	:
City	:	JUNEAU
State	:	AK
Zip	:	99801-8017
Country	:	US
Telephone Number	:	907-789-0131
Fax Number	:	907-789-7110

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. CHRISTINE MICHELLE MOLESKI
Credential	:	DMD
Telephone Number	:	907-789-0131

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/20/2015

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