MEDICARE: DR. BYRON JENARO MALILAY JUNIO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7305	NV
2	122300000X	Dentist	35779	TX
3	122300000X	Dentist	DD4947	NM
4	122300000X	Dentist	DE61238428	WA
5	1223G0001X	General Practice Dentistry	DD4947	NM
6	1223G0001X	General Practice Dentistry	7305	NV
7	1223G0001X	General Practice Dentistry	35779	TX
8	1223G0001X	General Practice Dentistry	DE61238428	WA

General Provider Information

NPI Number	:	1588150098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BYRON JENARO MALILAY JUNIO DMD

Provider Business Mailing Address
First Line	:	725 N 25 MILE AVE STE 110
Second Line	:
City	:	HEREFORD
State	:	TX
Zip	:	79045-3053
Country	:	US
Telephone Number	:	806-363-6690
Fax Number	:

Provider Business Practice Location Address
First Line	:	8129 LAKE BALLINGER WAY UNIT 101
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-9182
Country	:	US
Telephone Number	:	425-361-1343
Fax Number	:	425-582-8205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	09/01/2022

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