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Organization
M MALLEMPALLI PROFESSIONAL DENTAL CORPORATION
Active
Organization
M MALLEMPALLI PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANIMANJARI MALLEMPALLI DDS (DENTIST(PRESIDENT))
(760) 586-7056
Entity
Organization
Contact information
Practice address
600 PALM AVE., SUITE#116, IMPERIAL BEACH, CA 91932
(619) 628-8123
Mailing address
11412 FAIRWIND COURT, SAN DIEGO, CA 92130
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49586
CA
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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