Provider Demographics
NPI:1659047140
Name:MALOUF DENTAL CORP.
Entity Type:Organization
Organization Name:MALOUF DENTAL CORP.
Other - Org Name:THE SMILE FACTORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-348-8870
Mailing Address - Street 1:16700 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3243
Mailing Address - Country:US
Mailing Address - Phone:310-564-3676
Mailing Address - Fax:
Practice Address - Street 1:16700 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3243
Practice Address - Country:US
Practice Address - Phone:310-564-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty