Healthcare Provider Details

I. General information

NPI: 1730386202
Provider Name (Legal Business Name): JEFFREY SCOTT MALONE DMD.MHM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9530 POTRANCO RD
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

9530 POTRANCO RD
SAN ANTONIO TX
78251
US

V. Phone/Fax

Practice location:
  • Phone: 210-670-9000
  • Fax:
Mailing address:
  • Phone: 210-670-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: