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General NPI Number Information
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NPI Number | 1306897152
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Entity Type | Individual
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Provider Name | DAVID J MALOLEY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 100 WEST BEAVER CREEK BLVD SUITE 232
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City | AVON
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State | CO
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Zip | 81620
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Country | US
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Telephone | 979-949-3331
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2916
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City | AVON
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State | CO
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Zip | 81620-2900
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Country | US
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Telephone | 979-949-3331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6382
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8514
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10014
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License Number State | CO
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