Provider Demographics
NPI:1942683198
Name:MALONE DENTAL PLAZA, PC
Entity Type:Organization
Organization Name:MALONE DENTAL PLAZA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:518-521-3843
Mailing Address - Street 1:209 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-6400
Mailing Address - Country:US
Mailing Address - Phone:518-521-3843
Mailing Address - Fax:518-319-4242
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-6400
Practice Address - Country:US
Practice Address - Phone:518-521-3843
Practice Address - Fax:518-319-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0006491223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01535226Medicaid