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Individual

JAKE RODDIE MALONE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
4215 85TH ST, LUBBOCK, TX 79423-1931
(806) 794-1131
Mailing address
4215 85TH ST, LUBBOCK, TX 79423-1931
(432) 413-0314

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
35354
TX

Other

Enumeration date
07/24/2019
Last updated
06/16/2020
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