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General NPI Number Information
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NPI Number | 1366651176
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Entity Type | Organization
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Legal Business Name | RACHEL J. MALLYA, D.M.D., P.C
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 27 GARRETT RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-2302
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Country | US
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Telephone | 610-352-7766
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Fax | 610-352-6626
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Provider Business Mailing Address
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Address Line | 27 GARRETT RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-2302
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Country | US
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Telephone | 610-352-7766
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Fax | 610-352-6626
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RACHEL JACOB MALLYA
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Credential | D.M.D
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Telephone | 610-352-7766
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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 | DS026140-L
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License Number State | PA
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