Provider Demographics
NPI:1134240732
Name:MALOUF, RICHARD JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:MALOUF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3243
Mailing Address - Country:US
Mailing Address - Phone:469-348-8870
Mailing Address - Fax:
Practice Address - Street 1:16700 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3243
Practice Address - Country:US
Practice Address - Phone:469-348-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162061223G0001X, 1223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1479412-10Medicaid
TX1479412-14Medicaid
TX1479404-06Medicaid
TX1479412-06Medicaid
TX1479404-07Medicaid
TX1479412-01Medicaid
TX1479412-12Medicaid
TX1479404-05Medicaid
TX1479404-08Medicaid
TX1479412-07Medicaid
TX1479412-13Medicaid
TX1479412-05Medicaid
TX1479404-01Medicaid
TX1479404-04Medicaid
TX1479404-10Medicaid
TX1479412-08Medicaid
TX1479412-09Medicaid
TX1479404-09Medicaid
TX1479404-11Medicaid
TX1479412-11Medicaid