Healthcare Provider Details

I. General information

NPI: 1023869609
Provider Name (Legal Business Name): JALAL AHMAD ALMALLOUHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 W HURON ST
WATERFORD MI
48328-3677
US

IV. Provider business mailing address

1265 W HURON ST
WATERFORD MI
48328-3677
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-3327
  • Fax:
Mailing address:
  • Phone:
  • Fax: 248-977-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901602803
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: