Provider Demographics
NPI:1710058094
Name:MALAKOV, ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:MALAKOV
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 1:11223 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2937
Mailing Address - Country:US
Mailing Address - Phone:718-997-8288
Mailing Address - Fax:
Practice Address - Street 1:9123 QUEENS BLVD STE B
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5559
Practice Address - Country:US
Practice Address - Phone:718-205-2055
Practice Address - Fax:718-205-2355
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046977-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice