Healthcare Provider Details

I. General information

NPI: 1710858311
Provider Name (Legal Business Name): KATHERINE MALYSZEK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 COORS BLVD NW
ALBUQUERQUE NM
87114-6468
US

IV. Provider business mailing address

10010 COORS BLVD NW
ALBUQUERQUE NM
87114-6468
US

V. Phone/Fax

Practice location:
  • Phone: 505-420-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDB-2025-0103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: