MEDICARE: DR. DIANA T MALONE DDS.MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20402	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1312131	OTHER	TX	INS
2	0014940	OTHER	TX	INS

General Provider Information

NPI Number	:	1629275441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA T MALONE DDS.MS

Provider Business Mailing Address
First Line	:	4939 DE ZAVALA RD
Second Line	:	#102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2046
Country	:	US
Telephone Number	:	210-696-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	4939 DE ZAVALA RD
Second Line	:	#102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2046
Country	:	US
Telephone Number	:	210-696-3001
Fax Number	:

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/08/2007

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