Provider Demographics
NPI:1720127533
Name:MALKIEL, BARRY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:E
Last Name:MALKIEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W PIKE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3232
Mailing Address - Country:US
Mailing Address - Phone:770-995-9255
Mailing Address - Fax:
Practice Address - Street 1:415 W PIKE ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3232
Practice Address - Country:US
Practice Address - Phone:770-995-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice