Provider Demographics
NPI:1326397381
Name:K. MICHELLE MALDON, DMD PC
Entity Type:Organization
Organization Name:K. MICHELLE MALDON, DMD PC
Other - Org Name:PARK PLACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MALDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-323-0454
Mailing Address - Street 1:2001 PARK PL
Mailing Address - Street 2:835
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-2735
Mailing Address - Country:US
Mailing Address - Phone:205-323-0454
Mailing Address - Fax:205-323-0458
Practice Address - Street 1:2001 PARK PL
Practice Address - Street 2:835
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2735
Practice Address - Country:US
Practice Address - Phone:205-323-0454
Practice Address - Fax:205-323-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty