Individual
DR. STANISLAV MOLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MDS
Contact information
Practice address
2 CHUCRH ST, # 670, ELLINGTON, CT 06029-0670
(860) 000-0000
Mailing address
PO BOX 670, ELLINGTON, CT 06029-0670
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
009473
CT
Other
Enumeration date
08/09/2006
Last updated
05/09/2011
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