Provider Demographics
NPI:1194360271
Name:TINA MALAKOVA DENTAL SERVICES P.C.
Entity Type:Organization
Organization Name:TINA MALAKOVA DENTAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEVTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-744-4811
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:718-500-4560
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental