Provider Demographics
NPI:1972985984
Name:MALEK, JOANNE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:MALEK
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:S68W12662 BRISTLECONE LN
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-3503
Mailing Address - Country:US
Mailing Address - Phone:414-759-4397
Mailing Address - Fax:
Practice Address - Street 1:S68W12662 BRISTLECONE LN
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-3503
Practice Address - Country:US
Practice Address - Phone:414-759-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3093016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist