Provider Demographics
NPI:1225576085
Name:MALHOTRA & RENUSCH DDS PC
Entity Type:Organization
Organization Name:MALHOTRA & RENUSCH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-280-2060
Mailing Address - Street 1:30301 WOODWARD AVE
Mailing Address - Street 2:STE. 220
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0979
Mailing Address - Country:US
Mailing Address - Phone:248-208-2060
Mailing Address - Fax:
Practice Address - Street 1:30301 WOODWARD AVE
Practice Address - Street 2:STE. 220
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0979
Practice Address - Country:US
Practice Address - Phone:248-208-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty