Provider Demographics
NPI:1174567358
Name:MALONEY, JOHN J JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MALONEY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAKE SHORE DR
Mailing Address - Street 2:P. O. 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1862OtherDELTA DENTAL
MAX12454OtherBLUE CROSS BLUE SHIELD MA
NH844366OtherOTHER PROVIDER
NH89192106Medicaid
MAX12454OtherBLUE CROSS BLUE SHIELD MA