Provider Demographics
NPI:1932321791
Name:MALONE, ROXANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 US HIGHWAY 1
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-1611
Mailing Address - Country:US
Mailing Address - Phone:772-589-6667
Mailing Address - Fax:772-581-2968
Practice Address - Street 1:1511 US HIGHWAY 1
Practice Address - Street 2:SUITE 201
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-1611
Practice Address - Country:US
Practice Address - Phone:772-589-6667
Practice Address - Fax:772-581-2968
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN138971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice