Provider Demographics
NPI:1831820653
Name:MALONE, JENNA (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 48TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-2703
Mailing Address - Country:US
Mailing Address - Phone:813-909-6491
Mailing Address - Fax:
Practice Address - Street 1:5889 FORBES AVE STE 305
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1682
Practice Address - Country:US
Practice Address - Phone:412-521-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist