Provider Demographics
NPI:1043679004
Name:MOLAR DENTAL, LTD
Entity type:Organization
Organization Name:MOLAR DENTAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORNELIUS (NEIL)
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-256-5250
Mailing Address - Street 1:572 SMITHFIELD RD
Mailing Address - Street 2:UNIT 17
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3892
Mailing Address - Country:US
Mailing Address - Phone:401-256-5250
Mailing Address - Fax:401-270-9937
Practice Address - Street 1:572 SMITHFIELD RD
Practice Address - Street 2:UNIT 17
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3892
Practice Address - Country:US
Practice Address - Phone:401-256-5250
Practice Address - Fax:401-270-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN027371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty