1417942624 NPI number — KATHALYN AINE MALONE DDS

Table of content: KATHALYN AINE MALONE DDS (NPI 1417942624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417942624 NPI number — KATHALYN AINE MALONE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALONE
Provider First Name:
KATHALYN
Provider Middle Name:
AINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1417942624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL RITO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87530-0237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-581-4728
Provider Business Mailing Address Fax Number:
505-581-4789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 571
Provider Second Line Business Practice Location Address:
#28
Provider Business Practice Location Address City Name:
EL RITO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-581-4728
Provider Business Practice Location Address Fax Number:
505-581-4789
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD2569 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: D7553 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 0021242 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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