Provider Demographics
NPI:1205054723
Name:BOONE II, MALCOLM EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:EDWARD
Last Name:BOONE II
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 1:8456 N HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9119
Mailing Address - Country:US
Mailing Address - Phone:303-799-1715
Mailing Address - Fax:303-799-1717
Practice Address - Street 1:1727 GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1205
Practice Address - Country:US
Practice Address - Phone:303-388-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1043021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice