Provider Demographics
NPI:1043507890
Name:BREMEN, MOLLY (DDS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BREMEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FLEUR DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-3111
Mailing Address - Country:US
Mailing Address - Phone:515-650-4441
Mailing Address - Fax:515-630-1916
Practice Address - Street 1:7600 FLEUR DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-3111
Practice Address - Country:US
Practice Address - Phone:515-650-4441
Practice Address - Fax:515-630-1916
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-091771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty