Provider Demographics
NPI:1760400022
Name:MALLER, STEVEN CHARLES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:MALLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1660
Mailing Address - Country:US
Mailing Address - Phone:210-824-0111
Mailing Address - Fax:210-828-9103
Practice Address - Street 1:4501 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1660
Practice Address - Country:US
Practice Address - Phone:210-824-0111
Practice Address - Fax:210-828-9103
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58911223P0300X
TX278511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics