Provider Demographics
NPI:1265954705
Name:MALAGAYO, MARII (DDS)
Entity type:Individual
Prefix:
First Name:MARII
Middle Name:
Last Name:MALAGAYO
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 1:10422 HUEBNER RD APT 2602
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1392
Mailing Address - Country:US
Mailing Address - Phone:806-782-5379
Mailing Address - Fax:
Practice Address - Street 1:12055 VANCE JACKSON RD # 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-6058
Practice Address - Country:US
Practice Address - Phone:210-529-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist