| Dr Jerry B Malleus | |
|
125 S Brand Blvd San Fernando CA 91340-3304 | |
| (818) 365-6321 | |
| (818) 365-0011 |
| Full Name | Dr Jerry B Malleus |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 125 S Brand Blvd, San Fernando, California |
| Authorized Official Name and Position | Larry E Ferguson (BUSINESS MANAGER) |
| Authorized Official Contact | 8183656321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jerry B Malleus 125 S Brand Blvd San Fernando CA 91340-3304 Ph: (818) 365-6321 | Dr Jerry B Malleus 125 S Brand Blvd San Fernando CA 91340-3304 Ph: (818) 365-6321 |
| NPI Number | 1568784569 |
|---|---|
| Provider Enumeration Date | 02/18/2010 |
| Last Update Date | 02/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568784569 | NPI | - | NPPES |
| 24826 | Other | CA | CALIFORNIA BOARD OF DENTAL EXAMINERS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 24826 (California) | Primary |
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