MEDICARE: DR. SANDRA MOLINAS D.D.S

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	1223P0300X	Periodontics	0440791	NY

General Provider Information

NPI Number	:	1285776021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA MOLINAS D.D.S

Provider Business Mailing Address
First Line	:	2734 ARLINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4807
Country	:	US
Telephone Number	:	917-885-4714
Fax Number	:	718-597-8869

Provider Business Practice Location Address
First Line	:	2734 ARLINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4807
Country	:	US
Telephone Number	:	917-885-4714
Fax Number	:	718-597-8869

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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