Individual provider Active NPI

Carolyn Jean Malon, D.D.S.

  • General Practice Dentistry
  • Farmington, CT
National Provider Identifier
1922119593
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6734 Issued in CT
Practice address
200 Mountain Rd
Farmington, CT 06032-2461
Phone
(860) 677-8687
Fax
(860) 677-8684
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6734 CT Primary

Addresses

Primary practice location

200 Mountain Rd
Farmington, CT 06032-2461

Mailing address

200 Mountain Rd
Farmington, CT 06032-2461
Phone (860) 677-8687

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150314000319 CT Order and Referring Only - DentistPractitioner - Dentist 7810213600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6734CTMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922119593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MOUNTAIN RD",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322461",
            "telephone_number": "860-677-8687",
            "fax_number": "860-677-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MOUNTAIN RD",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322461",
            "telephone_number": "860-677-8687",
            "fax_number": "860-677-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALON",
        "first_name": "CAROLYN",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "6734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.