1194888099 NPI number — MR. MICHAEL E MOLONY DMD PSC

Table of content: MR. MICHAEL E MOLONY DMD PSC (NPI 1194888099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194888099 NPI number — MR. MICHAEL E MOLONY DMD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLONY
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DMD PSC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLONY
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD PSC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194888099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2220 GRANDVIEW DRIVE
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
FT MITCHELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-0400
Provider Business Practice Location Address Fax Number:
859-344-8980
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4458 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 501030 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 60044583 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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