Healthcare Provider Details

I. General information

NPI: 1295891521
Provider Name (Legal Business Name): F. R. MALOCH, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 BARTLETT ST
HOUSTON TX
77098-5212
US

IV. Provider business mailing address

2304 BARTLETT ST
HOUSTON TX
77098-5212
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-1731
  • Fax: 713-526-5689
Mailing address:
  • Phone: 713-797-1731
  • Fax: 713-526-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number14951
License Number StateTX

VIII. Authorized Official

Name: DR. FREDERICK RICHARD MALOCH
Title or Position: DIRECTOR
Credential: D.D.S.
Phone: 713-797-1731