Healthcare Provider Details

I. General information

NPI: 1245269422
Provider Name (Legal Business Name): DIDIER-DAVID ANTOINE MALIS D.M.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST 2237
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

PO BOX 201088
HOUSTON TX
77216-1088
US

V. Phone/Fax

Practice location:
  • Phone: 713-790-4600
  • Fax:
Mailing address:
  • Phone: 713-500-3500
  • Fax: 713-500-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberF22203
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: