Provider Demographics
NPI:1992030969
Name:MALONE, KATHERINE BODFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BODFORD
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 1:550 TOWN CREEK RD E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6289
Mailing Address - Country:US
Mailing Address - Phone:865-766-4884
Mailing Address - Fax:
Practice Address - Street 1:550 TOWN CREEK RD E
Practice Address - Street 2:SUITE 101
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6289
Practice Address - Country:US
Practice Address - Phone:865-766-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9031122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist