Healthcare Provider Details

I. General information

NPI: 1770386187
Provider Name (Legal Business Name): NATHAN THOMAS MALONEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CONCORD PKWY S STE 110A
CONCORD NC
28027-2704
US

IV. Provider business mailing address

280 CONCORD PKWY S STE 110A
CONCORD NC
28027-2704
US

V. Phone/Fax

Practice location:
  • Phone: 704-920-1070
  • Fax: 704-920-1071
Mailing address:
  • Phone: 704-920-1000
  • Fax: 704-934-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number151478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: