Carissa Molina, D.D.S.
Individual provider Active NPI Pediatric Dentistry · Brush, CO
NPI 1609219757 · NPPES record last updated Jul 17, 2019
Key facts
- NPI
- 1609219757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- License
- DEN.00203913 (CO)
- Practice address
- 242 Cambridge St
Brush, CO 80723-1608 - Phone
- (970) 387-3787
- NPI assigned
- Apr 9, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160531001143 | WI | Order and Referring Only - Other (Non-Physician) | 5395035570 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001139 | WI | MD | General Practice Dentistry |
| 7140-15 | WI | MD | General Practice Dentistry |
| DEN.00203913 | CO | MD | Pediatric Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DEN.00203913 | CO | Yes |
| General Practice Dentistry | 1223G0001X | 7140-15 | WI |
Addresses
Primary practice location
242 Cambridge St
Brush, CO 80723-1608
Mailing address
255 N Washington St Unit 118
Denver, CO 80203-4279
Other practice location 1
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Phone (414) 935-8000
Other providers in Brush, CO
- Crystal Meza
- Jaime Michel
- Alysse Milano
- Katie Miller
- Mindcare Solutions PC
- Michael Monarch
- Morgan County Chiropractic, P.C.
- Morgan County Dental Care PC
- Morgan County District Re2J
- Jackie Nelson
All providers in Brush, CO · Pediatric Dentistry in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.