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Organization
SAN FERNANDO DENTAL CENTER
Active
Organization
SAN FERNANDO DENTAL CENTER
Active
Other names
Dr Jerry B Malleus
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY E FERGUSON (BUSINESS MANAGER)
(818) 365-6321
Entity
Organization
Contact information
Practice address
125 S BRAND BLVD, SAN FERNANDO, CA 91340-3304
(818) 365-6321
(818) 365-0011
Mailing address
125 S BRAND BLVD, SAN FERNANDO, CA 91340-3304
(818) 365-6321
(818) 365-0011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24826
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24826
CALIFORNIA BOARD OF DENTAL EXAMINERS
CA
Enumeration date
02/18/2010
Last updated
02/18/2010
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