Provider Demographics
NPI:1003196445
Name:MALAKOVA, ALEVTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEVTINA
Middle Name:
Last Name:MALAKOVA
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 1:10025 QUEENS BLVD APT 5S
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2460
Mailing Address - Country:US
Mailing Address - Phone:718-744-4811
Mailing Address - Fax:
Practice Address - Street 1:9123 QUEENS BLVD STE B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5559
Practice Address - Country:US
Practice Address - Phone:718-205-2055
Practice Address - Fax:718-205-2355
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist