Provider Demographics
NPI:1639579782
Name:MALOVOS, GERALD ANDRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ANDRES
Last Name:MALOVOS
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 1:200 N LA CUMBRE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1577
Mailing Address - Country:US
Mailing Address - Phone:805-687-9700
Mailing Address - Fax:805-687-9703
Practice Address - Street 1:200 N LA CUMBRE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1577
Practice Address - Country:US
Practice Address - Phone:805-687-9700
Practice Address - Fax:805-687-9703
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics