=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508755752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE MALITO DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2025
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 968 1ST INFANTRY DIVISION RD
-----------------------------------------------------
City | FORT KNOX
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40121-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-626-8303
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22081 SOMERSET CT
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60423-8531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-909-6237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 11390
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------