Provider Demographics
NPI:1316160708
Name:MALOUF, CONSTANTINE GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:GEORGE
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 1:850 FM 1960 RD W
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3418
Mailing Address - Country:US
Mailing Address - Phone:281-893-3144
Mailing Address - Fax:281-893-8996
Practice Address - Street 1:850 FM 1960 RD W
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3418
Practice Address - Country:US
Practice Address - Phone:281-893-3144
Practice Address - Fax:281-893-8996
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB19842-01Medicaid