Provider Demographics
NPI:1184648396
Name:MALONE, PATRICK ROY
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ROY
Last Name:MALONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 OVERTON RIDGE BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1940
Mailing Address - Country:US
Mailing Address - Phone:817-370-1777
Mailing Address - Fax:
Practice Address - Street 1:4900 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1940
Practice Address - Country:US
Practice Address - Phone:817-370-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice