Healthcare Provider Details

I. General information

NPI: 1497859417
Provider Name (Legal Business Name): JAMES MALOOLEY JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8782 MADISON AVE
INDIANAPOLIS IN
46227-7202
US

IV. Provider business mailing address

8782 MADISON AVE
INDIANAPOLIS IN
46227-7202
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-2882
  • Fax: 317-882-8986
Mailing address:
  • Phone: 317-882-2882
  • Fax: 317-882-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7041
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: