1871709675 NPI number — JOHN J. MALONEY, JR. D.D.S.

Table of content: (NPI 1871709675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871709675 NPI number — JOHN J. MALONEY, JR. D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN J. MALONEY, JR. D.D.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871709675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 LAKESHORE DR
Provider Second Line Business Mailing Address:
PO BOX 1270
Provider Business Mailing Address City Name:
SEABROOK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03874-4028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-474-9506
Provider Business Mailing Address Fax Number:
603-474-7138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 LAKE SHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEABROOK
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03874-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-474-9506
Provider Business Practice Location Address Fax Number:
603-474-7138
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MALONEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-474-9506

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1862 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: X12454 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174567358 . This is a "NPI FOR DR. MALONEY" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 844366 . This is a "OTHER PROVIDER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 89192106 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1862 . This is a "LICENCE NO. & DELTA ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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