Provider Demographics
NPI:1083374482
Name:MALLARI, DANICA CHARISMA (DMD)
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:CHARISMA
Last Name:MALLARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 CLAIREMONT DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6766
Mailing Address - Country:US
Mailing Address - Phone:858-200-0827
Mailing Address - Fax:
Practice Address - Street 1:2995 CLAIREMONT DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6766
Practice Address - Country:US
Practice Address - Phone:858-200-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS107163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist