Provider Demographics
NPI:1750593950
Name:MALONE TRAHEY & SIMON DDS MS PA
Entity type:Organization
Organization Name:MALONE TRAHEY & SIMON DDS MS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HONEGCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:CDA COA
Authorized Official - Phone:704-784-3611
Mailing Address - Street 1:845 CHURCH STREET NORTH
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-784-3611
Mailing Address - Fax:704-721-3224
Practice Address - Street 1:845 CHURCH STREET NORTH
Practice Address - Street 2:SUITE 301
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-784-3611
Practice Address - Fax:704-721-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56111223X0400X
NC59591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty