Provider Demographics
NPI:1447776513
Name:MALONEY, TRISHA (DMD)
Entity type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:
Last Name:MALONEY
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 1:25 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1745
Mailing Address - Country:US
Mailing Address - Phone:954-554-0954
Mailing Address - Fax:
Practice Address - Street 1:272 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114
Practice Address - Country:US
Practice Address - Phone:860-296-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16323122300000X
MADN18580651223P0221X
CT122631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist