Provider Demographics
NPI:1770865404
Name:MALHOTRA, ASHU (DDS)
Entity Type:Individual
Prefix:
First Name:ASHU
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRANDVIEW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2519
Mailing Address - Country:US
Mailing Address - Phone:860-569-9996
Mailing Address - Fax:
Practice Address - Street 1:5270 ELMORE AVE STE 4
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3466
Practice Address - Country:US
Practice Address - Phone:563-209-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA88771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice