Provider Demographics
NPI:1912380411
Name:MALONE, ANNA (DMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 STATE ST STE C
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4949
Mailing Address - Country:US
Mailing Address - Phone:812-945-5100
Mailing Address - Fax:812-945-5101
Practice Address - Street 1:2241 STATE ST STE C
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4949
Practice Address - Country:US
Practice Address - Phone:812-945-5100
Practice Address - Fax:812-945-5101
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10213122300000X
IN12013576A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist