Healthcare Provider Details

I. General information

NPI: 1306365044
Provider Name (Legal Business Name): DAVID ABDELMALAK, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 N BRAND BLVD
GLENDALE CA
91202-2906
US

IV. Provider business mailing address

1023 N BRAND BLVD
GLENDALE CA
91202-2906
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-8955
  • Fax: 818-242-8995
Mailing address:
  • Phone: 818-242-8955
  • Fax: 818-242-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number101367
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID ABDELMALAK
Title or Position: PRESIDENT
Credential: DDS
Phone: 818-242-8955