Healthcare Provider Details

I. General information

NPI: 1124711270
Provider Name (Legal Business Name): MADISON DIETRICH MALONE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 NW PROFESSIONAL DR
CORVALLIS OR
97330-3881
US

IV. Provider business mailing address

1132 INN KEEPERS WAY
CORNELIUS NC
28031-8166
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-7708
  • Fax:
Mailing address:
  • Phone: 284-425-3598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11991
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: