Provider Demographics
NPI:1174183990
Name:MALONE & COSTA, PLLC
Entity Type:Organization
Organization Name:MALONE & COSTA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:865-539-1776
Mailing Address - Street 1:264 S PETERS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5203
Mailing Address - Country:US
Mailing Address - Phone:865-539-1776
Mailing Address - Fax:865-539-1585
Practice Address - Street 1:264 S PETERS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5203
Practice Address - Country:US
Practice Address - Phone:865-539-1776
Practice Address - Fax:865-539-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty