Provider Demographics
NPI:1508225210
Name:MALLET, MARKEYA MON'A (DA)
Entity Type:Individual
Prefix:
First Name:MARKEYA
Middle Name:MON'A
Last Name:MALLET
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-3530
Mailing Address - Country:US
Mailing Address - Phone:832-348-7243
Mailing Address - Fax:
Practice Address - Street 1:1620 ROSS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-3530
Practice Address - Country:US
Practice Address - Phone:832-348-7243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant