Provider Demographics
NPI:1760662621
Name:BALACHANDRAN IYER, MALINI (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:MALINI
Middle Name:
Last Name:BALACHANDRAN IYER
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:DR
Other - First Name:MALINI
Other - Middle Name:CHANDRAPILLY
Other - Last Name:BALACHANDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:3150 W WARD RD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-3056
Mailing Address - Country:US
Mailing Address - Phone:301-855-0880
Mailing Address - Fax:
Practice Address - Street 1:3150 W WARD RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3056
Practice Address - Country:US
Practice Address - Phone:301-855-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022395001223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program