Provider Demographics
NPI:1578652475
Name:MALOLO, LAURI NEIL (BA, RDH)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:NEIL
Last Name:MALOLO
Suffix:
Gender:F
Credentials:BA, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 E COTTON CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6134
Mailing Address - Country:US
Mailing Address - Phone:480-635-0345
Mailing Address - Fax:
Practice Address - Street 1:2483 S MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0722
Practice Address - Country:US
Practice Address - Phone:480-857-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2596124Q00000X
OHDH-8961124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist