Provider Demographics
NPI:1134389786
Name:MALONE, MATTHEW JOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOEL
Last Name:MALONE
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 1:2103 LEANNE AVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-5100
Mailing Address - Country:US
Mailing Address - Phone:509-765-1522
Mailing Address - Fax:
Practice Address - Street 1:123 W FRANCIS AVE STE 103
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6348
Practice Address - Country:US
Practice Address - Phone:509-489-8863
Practice Address - Fax:509-489-8744
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60026415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist