Provider Demographics
NPI:1457880791
Name:MALAMOU, CHARIKLEIA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:CHARIKLEIA
Middle Name:
Last Name:MALAMOU
Suffix:
Gender:F
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 1:355 W MORRIS ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1059
Mailing Address - Country:US
Mailing Address - Phone:607-776-6600
Mailing Address - Fax:
Practice Address - Street 1:355 W MORRIS ST STE 105
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1059
Practice Address - Country:US
Practice Address - Phone:607-776-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061082122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program