Active NPI
Michael Wayne Malone, D.D.S.
- Dentist
- Rolla, MO
National Provider Identifier
1073766291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13022
- Practice address
- 800 North State Street
Rolla, MO 65401 - Phone
- (573) 364-2575
- Fax
- (573) 364-1831
- NPI assigned
- Oct 31, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13022 | MO | Primary |
Addresses
Primary practice location
800 North State Street
Rolla, MO 65401
Mailing address
800 North State Street
Rolla, MO 65401
Phone (573) 364-2575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13022 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225411200000",
"number": "1073766291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 NORTH STATE STREET",
"city": "ROLLA",
"state": "MO",
"postal_code": "65401",
"telephone_number": "573-364-2575",
"fax_number": "573-364-1831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 NORTH STATE STREET",
"city": "ROLLA",
"state": "MO",
"postal_code": "65401",
"telephone_number": "573-364-2575",
"fax_number": "573-364-1831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONE",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-31",
"last_updated": "2008-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "13022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.