Provider Demographics
NPI:1346386448
Name:MALEK, MOODY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOODY
Middle Name:W
Last Name:MALEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 E ALVIN DR
Mailing Address - Street 2:SUITE J-1
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3056
Mailing Address - Country:US
Mailing Address - Phone:831-442-0620
Mailing Address - Fax:831-442-0647
Practice Address - Street 1:631 E ALVIN DR
Practice Address - Street 2:SUITE J-1
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3056
Practice Address - Country:US
Practice Address - Phone:831-442-0620
Practice Address - Fax:831-442-0647
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist