Provider Demographics
NPI:1598958415
Name:DAMON-MALLETTE, DEZBAA ALTAALKII (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEZBAA
Middle Name:ALTAALKII
Last Name:DAMON-MALLETTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DEZBAA
Other - Middle Name:ALTAALKII
Other - Last Name:DAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:P.O. BOX 3367
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305
Mailing Address - Country:US
Mailing Address - Phone:505-444-0329
Mailing Address - Fax:
Practice Address - Street 1:07 CHOOSHGAI DR.
Practice Address - Street 2:
Practice Address - City:TOHATCHI
Practice Address - State:NM
Practice Address - Zip Code:87325
Practice Address - Country:US
Practice Address - Phone:505-733-8440
Practice Address - Fax:505-733-2384
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008231122300000X
NMDD4027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist