# STEPHEN C MALLOW DBA UPPER TRACT DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Upper Tract Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083395081
- **Authorized official:** LISA D MALLOW (OFFICE MANAGER)
- **Authorized official phone:** (304) 358-8152

## Contact information

- **Practice address:** 9030 PETERSBURG PIKE, UPPER TRACT, WV 26866-8014
- **Practice address phone:** (304) 358-7200
- **Practice address fax:** (304) 358-7284
- **Mailing address:** 8791 PETERSBURG PIKE, UPPER TRACT, WV 26866-8016
- **Mailing address phone:** (304) 358-8152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/31/2023
- **Last updated:** 08/03/2023