Provider Demographics
NPI:1912690140
Name:MISHEL MALHOTRA DMD DENTAL CORP
Entity Type:Organization
Organization Name:MISHEL MALHOTRA DMD DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MISHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-575-9200
Mailing Address - Street 1:70 STONY POINT RD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4460
Mailing Address - Country:US
Mailing Address - Phone:707-575-9200
Mailing Address - Fax:
Practice Address - Street 1:70 STONY POINT RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4460
Practice Address - Country:US
Practice Address - Phone:707-575-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104438OtherDENTAL LICENSE