Individual
DR. SANJAY M MALLYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
9026
CT
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
SP-251
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004010807
—
CT
Enumeration date
10/18/2005
Last updated
03/02/2010
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