Provider Demographics
NPI:1295260768
Name:MALEEH, IMAD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:IMAD
Middle Name:
Last Name:MALEEH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12587 HESPERIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8308
Mailing Address - Country:US
Mailing Address - Phone:760-964-8963
Mailing Address - Fax:760-951-5446
Practice Address - Street 1:12587 HESPERIA RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8308
Practice Address - Country:US
Practice Address - Phone:760-964-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327611223X0400X
CA1011821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics