Provider Demographics
NPI:1295886422
Name:GERSHONY, MALINDA LAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:LAM
Last Name:GERSHONY
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 1:6628 188TH PL NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-8599
Mailing Address - Country:US
Mailing Address - Phone:425-885-9851
Mailing Address - Fax:425-885-9851
Practice Address - Street 1:15955 NE 85TH ST
Practice Address - Street 2:#101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3550
Practice Address - Country:US
Practice Address - Phone:425-883-2933
Practice Address - Fax:425-885-0146
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE93071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice