Provider Demographics
NPI:1861488603
Name:MAIELLO, RALPH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:J
Last Name:MAIELLO
Suffix:
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 1:495 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7706
Mailing Address - Country:US
Mailing Address - Phone:805-584-2228
Mailing Address - Fax:805-584-0621
Practice Address - Street 1:495 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7706
Practice Address - Country:US
Practice Address - Phone:805-584-2228
Practice Address - Fax:805-584-0621
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice