Provider Demographics
NPI:1336729938
Name:ASHAMALLA, MARCO K (DMD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:K
Last Name:ASHAMALLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W 25TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1727
Mailing Address - Country:US
Mailing Address - Phone:201-515-7691
Mailing Address - Fax:
Practice Address - Street 1:121 W 25TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1727
Practice Address - Country:US
Practice Address - Phone:201-515-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program