Healthcare Provider Details

I. General information

NPI: 1265949903
Provider Name (Legal Business Name): JODECI MALIXI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 N MILITARY TRL STE U
WEST PALM BEACH FL
33409-4764
US

IV. Provider business mailing address

1274 VIA PANZANI
BOYNTON BEACH FL
33426-8246
US

V. Phone/Fax

Practice location:
  • Phone: 561-683-7699
  • Fax:
Mailing address:
  • Phone: 802-829-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0160133837
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.026064
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: