Provider Demographics
NPI:1821203779
Name:MALABANAN, BEN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:MALABANAN
Suffix:JR
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 1:655 HARMON LOOP RD
Mailing Address - Street 2:SUITE 107 PNB 201
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:671-649-4446
Mailing Address - Fax:671-646-8443
Practice Address - Street 1:2011 ROUTE 16, MANHATTAN PLAZA BUILDING
Practice Address - Street 2:SUITE 201-202
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929
Practice Address - Country:US
Practice Address - Phone:671-649-4446
Practice Address - Fax:671-646-8443
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD-9791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice