Provider Demographics
NPI:1740240878
Name:MALONE, JACQUELINE MICHELLE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:MALONE
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Gender:F
Credentials:DMD, MS
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Mailing Address - Street 1:3005 ROYAL BLVD S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1409
Mailing Address - Country:US
Mailing Address - Phone:770-619-1776
Mailing Address - Fax:770-619-1730
Practice Address - Street 1:3005 ROYAL BLVD S
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1409
Practice Address - Country:US
Practice Address - Phone:770-619-1776
Practice Address - Fax:770-619-1730
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADN0115601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics