Organization
M MALLEMPALLI PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANIMANJARI MALLEMPALLI DDS (PRESIDENT)
(619) 628-8123
Entity
Organization
Contact information
Practice address
600 PALM AVE STE 116, IMPERIAL BEACH, CA 91932-1245
(619) 628-8123
Mailing address
11412 FAIRWIND CT, SAN DIEGO, CA 92130-8641
(760) 586-7056
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
49586
CA
Other
Enumeration date
04/06/2018
Last updated
04/06/2018
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