Provider Demographics
NPI:1679726525
Name:MALAKUTI, CAROLINE (DMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:MALAKUTI
Suffix:
Gender:F
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 1/2 SOUTH BEVERLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-920-0903
Mailing Address - Fax:310-274-8109
Practice Address - Street 1:241 1/2 S. BEVERLY DR.
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3807
Practice Address - Country:US
Practice Address - Phone:310-920-0903
Practice Address - Fax:310-274-8109
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice