1942557103 NPI number — DR. NIKOLAY DIMITROV MOLLOV D.D.S.

Table of content: DR. NIKOLAY DIMITROV MOLLOV D.D.S. (NPI 1942557103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942557103 NPI number — DR. NIKOLAY DIMITROV MOLLOV D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLOV
Provider First Name:
NIKOLAY
Provider Middle Name:
DIMITROV
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942557103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 S VAN DORN ST
Provider Second Line Business Mailing Address:
APT. V604
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304-4254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-862-5959
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13975 CONNECTICUT AVE
Provider Second Line Business Practice Location Address:
SUITE 200-201
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20906-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-460-1212
Provider Business Practice Location Address Fax Number:
301-603-0861
Provider Enumeration Date:
08/07/2012

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: 1223X0400X , with the licence number:  15082 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 0401413531 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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