Provider Demographics
NPI:1518373273
Name:BARBARA MALLONEE, DDS, INC
Entity Type:Organization
Organization Name:BARBARA MALLONEE, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALLONEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-702-1455
Mailing Address - Street 1:2121 E COAST HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1931
Mailing Address - Country:US
Mailing Address - Phone:949-640-0222
Mailing Address - Fax:949-640-0333
Practice Address - Street 1:2121 E COAST HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1931
Practice Address - Country:US
Practice Address - Phone:949-640-0222
Practice Address - Fax:949-640-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29167332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609964451OtherNPI
1609964451OtherNPI