Provider Demographics
NPI:1629467113
Name:ANN MALOTKY, DDS., INC.
Entity Type:Organization
Organization Name:ANN MALOTKY, DDS., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOTKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-243-8806
Mailing Address - Street 1:1800 BUENAVENTURA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3700
Mailing Address - Country:US
Mailing Address - Phone:530-243-8806
Mailing Address - Fax:530-638-8866
Practice Address - Street 1:1800 BUENAVENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3700
Practice Address - Country:US
Practice Address - Phone:530-243-8806
Practice Address - Fax:530-638-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty