M Mallempalli Professional Dental Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

49586 Issued in CA

Legal business name

M MALLEMPALLI PROFESSIONAL DENTAL CORPORATION

Practice address

600 Palm Ave.
Suite#116
Imperial Beach, CA 91932

Phone

(619) 628-8123

NPI assigned

Apr 9, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Manimanjari Mallempalli, DDS

Title

Dentist(President)

Phone

(760) 586-7056

Specialties & licenses 1

Addresses

Tax ID family

M Mallempalli Professional Dental Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• M Mallempalli Professional Dental Corporation

  • Dental Clinic/Center
  • Imperial Beach, CA
  • NPI 1679070791
  NPD tax ID

Locations

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523232000000",
    "number": "1508363391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11412 FAIRWIND COURT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PALM AVE.",
            "address_2": "SUITE#116",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "91932",
            "telephone_number": "619-628-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M MALLEMPALLI PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-09",
        "last_updated": "2018-04-09",
        "status": "A",
        "authorized_official_last_name": "MALLEMPALLI",
        "authorized_official_first_name": "MANIMANJARI",
        "authorized_official_title_or_position": "DENTIST(PRESIDENT)",
        "authorized_official_telephone_number": "760-586-7056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabella Lydia Lopez, RADT I
• Melissa Lozano Morales, SUDRC
• Stephanie Luebbert, RN
• Luminosity Acupuncture, PC
• Steven Yee Luo, DDS
• M Mallempalli Professional Dental Corporation
• Flor Maria Macias Sanchez, BA
• Arnel Reyes Mariano, D.D.S.
• Alicia Martinez, MA
• Elena Dee Martinez

• General Practice Dentistry in Imperial Beach, CA
• Providers in Imperial Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.