Provider Demographics
NPI:1801922273
Name:MALLEMPALLI, MANIMANJARI (DDS)
Entity type:Individual
Prefix:DR
First Name:MANIMANJARI
Middle Name:
Last Name:MALLEMPALLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 MIRA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4816
Mailing Address - Country:US
Mailing Address - Phone:858-549-8045
Mailing Address - Fax:858-527-1572
Practice Address - Street 1:9359 MIRAMESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-549-8045
Practice Address - Fax:858-527-1572
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist