MEDICARE: DR. KATHERINE BODFORD MALONE D.D.S

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	122300000X	Dentist	9031	TN
2	1223P0221X	Pediatric Dentistry	9031	TN

General Provider Information

NPI Number	:	1992030969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE BODFORD MALONE D.D.S

Provider Business Mailing Address
First Line	:	550 TOWN CREEK RD E
Second Line	:	SUITE 101
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6289
Country	:	US
Telephone Number	:	865-766-4884
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 TOWN CREEK RD E
Second Line	:	SUITE 101
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6289
Country	:	US
Telephone Number	:	865-766-4884
Fax Number	:

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	06/07/2014

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Directions to “ DR. KATHERINE BODFORD MALONE D.D.S” Practice Location

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