NPIMap

Organization Active NPI

Drew Malidore, D.D.S., P.L.L.C.

  • Dental Clinic/Center
  • Port Orchard, WA
National Provider Identifier
1922296201
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7770 Issued in WA
Legal business name
DREW MALIDORE, D.D.S., P.L.L.C.
Practice address
6500 SE Mile Hill Dr
Port Orchard, WA 98366-8724
Phone
(360) 871-0788
Fax
(360) 871-6976
NPI assigned
Oct 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

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

Authorized official

Name
Dr. Drewett G Malidore, DDSNPI 1013991967
Title
Owner
Phone
(360) 871-0788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7770 WA Primary

Addresses

Primary practice location

6500 SE Mile Hill Dr
Port Orchard, WA 98366-8724

Mailing address

6500 SE Mile Hill Dr
Port Orchard, WA 98366-8724
Phone (360) 871-0788

Other identifiers 3

IdentifierTypeStateIssuer
1408327OtherUNITED CONCORDIA
59239OtherWDS
5040076MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337644800000",
    "number": "1922296201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 SE MILE HILL DR",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983668724",
            "telephone_number": "360-871-0788",
            "fax_number": "360-871-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 SE MILE HILL DR",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983668724",
            "telephone_number": "360-871-0788",
            "fax_number": "360-871-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DREW MALIDORE, D.D.S., P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2012-05-22",
        "status": "A",
        "authorized_official_last_name": "MALIDORE",
        "authorized_official_first_name": "DREWETT",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-871-0788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "7770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1408327",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WDS",
            "identifier": "59239",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040076",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.