Provider Demographics
NPI:1720227267
Name:MALONE, DORMAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORMAN
Middle Name:
Last Name:MALONE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 PARADISE VALLEY RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139
Mailing Address - Country:US
Mailing Address - Phone:619-479-5700
Mailing Address - Fax:619-479-2373
Practice Address - Street 1:6919 PARADISE VALLEY RD STE 1A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-1225
Practice Address - Country:US
Practice Address - Phone:619-479-5700
Practice Address - Fax:619-479-2373
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist