MEDICARE: DR. ROBERT BRIAN MOLLOY 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	1223P0221X	Pediatric Dentistry	5436	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100126100B	OTHER	OK	OKLAHOMA HEALTHCARE AUTHO

General Provider Information

NPI Number	:	1619162054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BRIAN MOLLOY D.D.S

Provider Business Mailing Address
First Line	:	9801 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6925
Country	:	US
Telephone Number	:	405-692-1222
Fax Number	:	405-703-0930

Provider Business Practice Location Address
First Line	:	9801 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6925
Country	:	US
Telephone Number	:	405-692-1222
Fax Number	:	405-703-0930

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	01/22/2013

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