Provider Demographics
NPI:1649717257
Name:MALHOTRA, MISHEL
Entity type:Individual
Prefix:
First Name:MISHEL
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 STONY POINT RD STE E
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4460
Mailing Address - Country:US
Mailing Address - Phone:707-575-9200
Mailing Address - Fax:707-575-4546
Practice Address - Street 1:70 STONY POINT RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4460
Practice Address - Country:US
Practice Address - Phone:707-575-9200
Practice Address - Fax:707-575-4546
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-21
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1044381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice