Provider Demographics
NPI:1295126258
Name:MALLEMPALLI DDS INC
Entity type:Organization
Organization Name:MALLEMPALLI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANIMANJARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLEMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-549-8045
Mailing Address - Street 1:9359 MIRA MESA BLVD
Mailing Address - Street 2:N/A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4816
Mailing Address - Country:US
Mailing Address - Phone:858-549-8045
Mailing Address - Fax:858-527-1572
Practice Address - Street 1:9359 MIRA MESA BLVD
Practice Address - Street 2:N/A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4816
Practice Address - Country:US
Practice Address - Phone:858-549-8045
Practice Address - Fax:858-527-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty