Provider Demographics
NPI:1487766879
Name:MOLINA, JUAN MANUEL (DDS)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
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 1:3859 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3531
Mailing Address - Country:US
Mailing Address - Phone:210-337-7114
Mailing Address - Fax:210-359-6489
Practice Address - Street 1:3859 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3531
Practice Address - Country:US
Practice Address - Phone:210-337-7114
Practice Address - Fax:210-359-6489
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist