Provider Demographics
NPI:1225114697
Name:MALOCH, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MALOCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1202 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5364
Mailing Address - Country:US
Mailing Address - Phone:772-335-3088
Mailing Address - Fax:772-398-0041
Practice Address - Street 1:1202 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5364
Practice Address - Country:US
Practice Address - Phone:772-335-3088
Practice Address - Fax:772-398-0041
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist