MEDICARE: WILLIAM M MALONE

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	2841	LA

General Provider Information

NPI Number	:	1447415500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM M MALONE

Provider Business Mailing Address
First Line	:	300 DOUCET RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3400
Country	:	US
Telephone Number	:	337-989-1268
Fax Number	:	337-989-1324

Provider Business Practice Location Address
First Line	:	300 DOUCET RD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3400
Country	:	US
Telephone Number	:	337-989-1268
Fax Number	:	337-989-1324

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM M MALONE
Credential	:	DDS
Telephone Number	:	337-989-1268

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/28/2008

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Directions to “WILLIAM M MALONE ” Practice Location

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