Provider Demographics
NPI:1023270675
Name:MOLINO, KENT BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:BRADLEY
Last Name:MOLINO
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 1:1771 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6311
Mailing Address - Country:US
Mailing Address - Phone:518-377-3628
Mailing Address - Fax:
Practice Address - Street 1:1771 UNION ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-6311
Practice Address - Country:US
Practice Address - Phone:518-377-3628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice