Provider Demographics
NPI:1689700221
Name:MOLINA, ROLANDO JESUS (DDS)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:JESUS
Last Name:MOLINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5991 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5037
Mailing Address - Country:US
Mailing Address - Phone:305-262-0505
Mailing Address - Fax:305-262-5075
Practice Address - Street 1:5991 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5037
Practice Address - Country:US
Practice Address - Phone:305-262-0505
Practice Address - Fax:305-262-5075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL143441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070420200Medicaid
FL070420201Medicaid