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General NPI Number Information
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NPI Number | 1285850677
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Entity Type | Organization
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Legal Business Name | R. PETER MALY DDS PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 43025 W TEN MILE RD.
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City | NOVI
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State | MI
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Zip | 48375-3456
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Country | US
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Telephone | 248-347-3700
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Fax | 248-347-1541
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Provider Business Mailing Address
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Address Line | 43025 W TEN MILE RD.
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City | NOVI
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State | MI
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Zip | 48375-3456
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Country | US
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Telephone | 248-347-3700
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Fax | 248-347-1541
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAYMOND PETER MALY
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Credential | D.D.S.
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Telephone | 248-347-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14108
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License Number State | MI
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