MEDICARE: DR. THOMAS ODELL MALONE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN 4072	DC

General Provider Information

NPI Number	:	1255474573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ODELL MALONE DDS

Provider Business Mailing Address
First Line	:	1341 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3027
Country	:	US
Telephone Number	:	202-547-6453
Fax Number	:	202-547-4575

Provider Business Practice Location Address
First Line	:	1341 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-3027
Country	:	US
Telephone Number	:	202-547-6453
Fax Number	:	202-547-4575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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