Provider Demographics
NPI:1558343608
Name:CARMAZI, MALKA (D D S)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:
Last Name:CARMAZI
Suffix:
Gender:F
Credentials:D D S
Other - Prefix:MRS
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:CARMAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D D S
Mailing Address - Street 1:19 MARTIN CT
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1619
Mailing Address - Country:US
Mailing Address - Phone:516-773-4585
Mailing Address - Fax:
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:ST B4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:718-763-4522
Practice Address - Fax:718-968-1182
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0396461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice