Individual provider Active NPI

Doni Rebecca Mallia, D.D.S.

  • General Practice Dentistry
  • Dexter, MI
National Provider Identifier
1306916879
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901017984 Issued in MI
Practice address
8048 5TH St
Dexter, MI 48130-1033
Phone
(734) 426-2220
NPI assigned
Nov 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901017984 MI Primary

Addresses

Primary practice location

8048 5TH St
Dexter, MI 48130-1033

Mailing address

8048 5TH St
Dexter, MI 48130-1033
Phone (734) 426-2220

Other identifiers 2

IdentifierTypeStateIssuer
4475754MedicaidMI
D800438OtherMIBLUECROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160301000247 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6608171699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Design 4 Sleep LLC CurrentSince Oct 10, 2022 Accepting new patients

Locations

8048 5th St
Dexter, MI 48130
Phone (734) 219-0343

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1306916879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8048 5TH ST",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301033",
            "telephone_number": "734-426-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8048 5TH ST",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481301033",
            "telephone_number": "734-426-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIA",
        "first_name": "DONI",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901017984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4475754",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "D800438",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dexter, MI

Sources for this page

Verify at the official NPI Registry.