Provider Demographics
NPI:1912380411
Name:MALONE, ANNA (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5501
Mailing Address - Country:US
Mailing Address - Phone:024-239-5555
Mailing Address - Fax:502-694-4470
Practice Address - Street 1:8403 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5501
Practice Address - Country:US
Practice Address - Phone:502-423-9555
Practice Address - Fax:502-694-4470
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10213122300000X
IN12013576A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist