Provider Demographics
NPI:1619374238
Name:MASLIAH, MAURICE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:K
Last Name:MASLIAH
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 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:STE 1158
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-820-5703
Mailing Address - Fax:310-826-3063
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:STE 1158
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-820-5703
Practice Address - Fax:310-826-3063
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist