| Jerry B Malleus, Dds Inc. | |
|
125 S Brand Blvd San Fernando CA 91340-3304 | |
| (818) 365-6321 | |
| (818) 365-0011 |
| Full Name | Jerry B Malleus, Dds Inc. |
|---|---|
| Speciality | Dentist |
| Location | 125 S Brand Blvd, San Fernando, California |
| Authorized Official Name and Position | Jerry B Malleus (PRES.) |
| Authorized Official Contact | 8188325102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerry B Malleus, Dds Inc. 125 S Brand Blvd San Fernando CA 91340-3304 Ph: (818) 365-6321 | Jerry B Malleus, Dds Inc. 125 S Brand Blvd San Fernando CA 91340-3304 Ph: (818) 365-6321 |
| NPI Number | 1922498302 |
|---|---|
| Provider Enumeration Date | 01/23/2015 |
| Last Update Date | 01/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922498302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 24826 (California) | Primary |
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