Provider Demographics
NPI:1487789889
Name:JAIRO H MOLTA DDS.INC.
Entity type:Organization
Organization Name:JAIRO H MOLTA DDS.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOLTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-440-0150
Mailing Address - Street 1:371 E BULLARD AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5217
Mailing Address - Country:US
Mailing Address - Phone:559-440-0150
Mailing Address - Fax:559-435-4370
Practice Address - Street 1:371 E BULLARD AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5217
Practice Address - Country:US
Practice Address - Phone:559-440-0150
Practice Address - Fax:559-435-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB53629-01OtherDELTA FSN,HFP
CAG93956-01OtherMEDICAL