Provider Demographics
NPI:1932312402
Name:MALYON, JEFFERY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:MALYON
Suffix:
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 1:14858 LAKE HILLS BLVD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5821
Mailing Address - Country:US
Mailing Address - Phone:425-746-5929
Mailing Address - Fax:425-746-9870
Practice Address - Street 1:14858 LAKE HILLS BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5821
Practice Address - Country:US
Practice Address - Phone:425-746-5929
Practice Address - Fax:425-746-9870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice