Provider Demographics
NPI:1801466313
Name:VANMALI, PINKY
Entity type:Individual
Prefix:DR
First Name:PINKY
Middle Name:
Last Name:VANMALI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PINKY
Other - Middle Name:
Other - Last Name:VANMALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2113 SCHAUB CT
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-4614
Mailing Address - Country:US
Mailing Address - Phone:678-995-2692
Mailing Address - Fax:
Practice Address - Street 1:922 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-3456
Practice Address - Country:US
Practice Address - Phone:407-449-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice