Provider Demographics
NPI:1942280078
Name:MOLLOHAN, WAYNE B (DMD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:B
Last Name:MOLLOHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-0029
Mailing Address - Country:US
Mailing Address - Phone:401-822-3390
Mailing Address - Fax:401-826-3060
Practice Address - Street 1:251 QUAKER LN
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2121
Practice Address - Country:US
Practice Address - Phone:401-822-3390
Practice Address - Fax:401-826-3060
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDNT18801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice