Provider Demographics
NPI:1770571507
Name:LUKE, MOLLY O'BRIEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:O'BRIEN
Last Name:LUKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2718
Mailing Address - Country:US
Mailing Address - Phone:660-864-3399
Mailing Address - Fax:
Practice Address - Street 1:960 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2718
Practice Address - Country:US
Practice Address - Phone:660-864-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3556122300000X
SC4224122300000X
PADS039436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist