Provider Demographics
NPI:1265184154
Name:MALANG, JOSE RAFAEL (DMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:MALANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 GRANDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8717
Mailing Address - Country:US
Mailing Address - Phone:207-329-5729
Mailing Address - Fax:
Practice Address - Street 1:221 N HOOKER AVE
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2231
Practice Address - Country:US
Practice Address - Phone:269-273-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist