Provider Demographics
NPI:1144776253
Name:MAX H MOLGARD JR, DDS, FACP, PLLC
Entity type:Organization
Organization Name:MAX H MOLGARD JR, DDS, FACP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOLGARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-327-4469
Mailing Address - Street 1:6817 N CEDAR RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4277
Mailing Address - Country:US
Mailing Address - Phone:509-327-4469
Mailing Address - Fax:
Practice Address - Street 1:6817 N CEDAR RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4277
Practice Address - Country:US
Practice Address - Phone:509-327-4469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605470381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty