Provider Demographics
NPI:1225583628
Name:JUSTIN W. MALONEY DDS
Entity Type:Organization
Organization Name:JUSTIN W. MALONEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:WALSH
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-747-4121
Mailing Address - Street 1:3201 S GRAND BLVD
Mailing Address - Street 2:PO BOX 8007
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2616
Mailing Address - Country:US
Mailing Address - Phone:509-747-4121
Mailing Address - Fax:
Practice Address - Street 1:3201 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2616
Practice Address - Country:US
Practice Address - Phone:509-747-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty