Organization
MAGNOLIA LANE DENTAL OF O FALLON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUTUMN MALONEY DMD (DENTIST)
(217) 779-4029
Entity
Organization
Contact information
Practice address
608 WOODLAWN AVE, O FALLON, MO 63366-2521
(217) 779-4029
Mailing address
104 SUNNYSIDE ESTATES CT, DARDENNE PRAIRIE, MO 63368-7617
(217) 779-4029
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/22/2026
Last updated
06/22/2026
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