Individual
MARY FARES MALLOUHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
394 MAIN ST, HACKENSACK, NJ 07601-5805
(201) 525-0067
(201) 525-0070
Mailing address
394 MAIN ST, HACKENSACK, NJ 07601-5805
(201) 525-0067
(201) 525-0070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI21703
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0114031
—
NJ
Enumeration date
03/19/2007
Last updated
01/14/2021
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