Provider Demographics
NPI:1124242037
Name:MALMON, HERBERT SHELDON (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:SHELDON
Last Name:MALMON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32515 GOLDEN LANTERN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3259
Mailing Address - Country:US
Mailing Address - Phone:949-661-2000
Mailing Address - Fax:949-661-4438
Practice Address - Street 1:32515 GOLDEN LANTERN ST
Practice Address - Street 2:SUITE D
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3259
Practice Address - Country:US
Practice Address - Phone:949-661-2000
Practice Address - Fax:949-661-4438
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 22004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist