Individual
JOHN CHARLES MALLOY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
115 FARLEY CIRCLE, SUITE 203, LEWISBURG, PA 17837
(570) 524-2828
(570) 524-9199
Mailing address
317 NORTH ELEVENTH STREET, SUNBURY, PA 17801
(570) 286-1631
(570) 286-0595
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DA031566
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS030741L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50017985
CAPITAL BLUE CROSS
PA
01
—
83988
GEISINGER HEALTH PLAN
PA
Enumeration date
06/06/2006
Last updated
07/08/2007
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