Provider Demographics
NPI:1720150535
Name:MALY, RAYMOND PETER (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PETER
Last Name:MALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:R
Other - Middle Name:PETER
Other - Last Name:MALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:43025 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3217
Mailing Address - Country:US
Mailing Address - Phone:248-347-3700
Mailing Address - Fax:
Practice Address - Street 1:43025 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-347-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID141081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice