Provider Demographics
NPI:1871709675
Name:JOHN J. MALONEY, JR. D.D.S.
Entity type:Organization
Organization Name:JOHN J. MALONEY, JR. D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-474-9506
Mailing Address - Street 1:4 LAKESHORE DR
Mailing Address - Street 2:PO BOX 1270
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4028
Mailing Address - Country:US
Mailing Address - Phone:603-474-9506
Mailing Address - Fax:603-474-7138
Practice Address - Street 1:4 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4028
Practice Address - Country:US
Practice Address - Phone:603-474-9506
Practice Address - Fax:603-474-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12454OtherBLUE CROSS BLUE SHIELD MA
NH1174567358OtherNPI FOR DR. MALONEY
NH844366OtherOTHER PROVIDER
NH89192106Medicaid
NH1862OtherLICENCE NO. & DELTA ID#
NH=========OtherTAX ID NUMBER