Provider Demographics
NPI:1659950319
Name:MALOO - CHICAS PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:MALOO - CHICAS PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUZAIFA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MALOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-929-2555
Mailing Address - Street 1:1001 E LATHAM AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4435
Mailing Address - Country:US
Mailing Address - Phone:951-929-2555
Mailing Address - Fax:951-925-2893
Practice Address - Street 1:1001 E LATHAM AVE STE D
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4435
Practice Address - Country:US
Practice Address - Phone:951-929-2555
Practice Address - Fax:951-925-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental