Active NPI
Charles M Malloy, DMD
- Prosthodontics
- Portland, OR
National Provider Identifier
1831274406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- D7264
- Practice address
- 2730 SW Moody Avenue
Portland, OR 97201-5042 - Phone
- (503) 494-4316
- Fax
- (503) 494-2365
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | D7264 | OR | Primary |
Addresses
Primary practice location
2730 SW Moody Avenue
Portland, OR 97201-5042
Mailing address
13685 SW Aerie Dr
Portland, OR 97223-2805
Phone (503) 579-8203
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 |
|---|---|---|---|
| D7264 | OR | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1831274406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13685 SW AERIE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972232805",
"telephone_number": "503-579-8203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 SW MOODY AVENUE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972015042",
"telephone_number": "503-494-4316",
"fax_number": "503-494-2365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLOY",
"first_name": "CHARLES",
"middle_name": "M",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "OR",
"license": "D7264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.