Provider Demographics
NPI:1700165503
Name:MALDDS
Entity Type:Organization
Organization Name:MALDDS
Other - Org Name:ELITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-342-8251
Mailing Address - Street 1:4877 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3627
Mailing Address - Country:US
Mailing Address - Phone:210-342-8251
Mailing Address - Fax:210-342-8257
Practice Address - Street 1:4877 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3627
Practice Address - Country:US
Practice Address - Phone:210-342-8251
Practice Address - Fax:210-342-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty