Provider Demographics
NPI:1093724254
Name:MALIZIA, DONALD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:MALIZIA
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 1:457 N MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2183
Mailing Address - Country:US
Mailing Address - Phone:570-299-7293
Mailing Address - Fax:570-299-7427
Practice Address - Street 1:457 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-2183
Practice Address - Country:US
Practice Address - Phone:570-299-7293
Practice Address - Fax:570-299-7427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 021757-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS021957LOtherDENTAL LICENSE