Provider Demographics
NPI:1477664969
Name:CAROLYN J. MALON, DDS AND STEPHEN M. MORA
Entity Type:Organization
Organization Name:CAROLYN J. MALON, DDS AND STEPHEN M. MORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-677-8687
Mailing Address - Street 1:200 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2461
Mailing Address - Country:US
Mailing Address - Phone:860-677-8687
Mailing Address - Fax:860-677-8684
Practice Address - Street 1:200 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2461
Practice Address - Country:US
Practice Address - Phone:860-677-8687
Practice Address - Fax:860-677-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty