MEDICARE: GABRIELLE MALETTE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901600215	MI

General Provider Information

NPI Number	:	1235782616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE MALETTE DDS

Provider Business Mailing Address
First Line	:	64845 VAN DYKE RD
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2836
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	64845 VAN DYKE RD
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2836
Country	:	US
Telephone Number	:	586-752-6596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/24/2019

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