Mallott Family Dental, Inc.

NPI #1457732208 in Columbia, Missouri

Provider Information

NPI Number: 1457732208
Entity Type: Organization
Organization Name: Mallott Family Dental, Inc.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 17, 2015
Last Updated: Jun 17, 2015

Practice Location

Address: 3320 BLUFF CREEK DR
Address 2: SUITE 100
City: Columbia
State: Missouri
ZIP Code: 65201-3501
Phone: (573) 875-5336

Authorized Official

Name: DR. JOHNATHAN L MALLOTT, D.D.S.
Title: PRESIDENT
Phone: (573) 875-5336

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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