Provider Demographics
NPI:1114289345
Name:MALONE, ELIZABETH MCMILLAN GREEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MCMILLAN GREEN
Last Name:MALONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1620
Mailing Address - Country:US
Mailing Address - Phone:864-439-6559
Mailing Address - Fax:864-439-1905
Practice Address - Street 1:206 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1620
Practice Address - Country:US
Practice Address - Phone:864-439-6559
Practice Address - Fax:864-439-1905
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice