MEDICARE: MALLEMPALLI DDS INC

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	122300000X	Dentist	49586	CA

General Provider Information

NPI Number	:	1295126258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALLEMPALLI DDS INC

Provider Business Mailing Address
First Line	:	9359 MIRA MESA BLVD
Second Line	:	N/A
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4816
Country	:	US
Telephone Number	:	858-549-8045
Fax Number	:	858-527-1572

Provider Business Practice Location Address
First Line	:	9359 MIRA MESA BLVD
Second Line	:	N/A
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4816
Country	:	US
Telephone Number	:	858-549-8045
Fax Number	:	858-527-1572

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MANIMANJARI MALLEMPALLI
Credential	:
Telephone Number	:	858-549-8045

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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