Provider Demographics
NPI:1710252200
Name:MALARIC, SPASKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPASKA
Middle Name:
Last Name:MALARIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ROYAL PALM SQUARE BLVD
Mailing Address - Street 2:101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-1074
Mailing Address - Country:US
Mailing Address - Phone:239-939-2433
Mailing Address - Fax:
Practice Address - Street 1:1400 ROYAL PALM SQUARE BLVD
Practice Address - Street 2:101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1074
Practice Address - Country:US
Practice Address - Phone:239-939-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 196551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice