Provider Demographics
NPI:1285850677
Name:R. PETER MALY DDS PC
Entity Type:Organization
Organization Name:R. PETER MALY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-347-3700
Mailing Address - Street 1:43025 W TEN MILE RD.
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3456
Mailing Address - Country:US
Mailing Address - Phone:248-347-3700
Mailing Address - Fax:248-347-1541
Practice Address - Street 1:43025 W TEN MILE RD.
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3456
Practice Address - Country:US
Practice Address - Phone:248-347-3700
Practice Address - Fax:248-347-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty