Provider Demographics
NPI:1467863357
Name:MALONOUKOS, PAVLOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAVLOS
Middle Name:
Last Name:MALONOUKOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15748 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1932
Mailing Address - Country:US
Mailing Address - Phone:917-251-6262
Mailing Address - Fax:
Practice Address - Street 1:1846 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2730
Practice Address - Country:US
Practice Address - Phone:516-378-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04308729Medicaid