Provider Demographics
NPI:1619417615
Name:MALEEH ORTHODONTICS DDS MS, INC.
Entity Type:Organization
Organization Name:MALEEH ORTHODONTICS DDS MS, INC.
Other - Org Name:MALEEH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:760-964-8963
Mailing Address - Street 1:20139 YUCCA LOMA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-5626
Mailing Address - Country:US
Mailing Address - Phone:760-964-8963
Mailing Address - Fax:
Practice Address - Street 1:12587 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8308
Practice Address - Country:US
Practice Address - Phone:760-964-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty