Organization
STEPHEN C MALLOW DBA UPPER TRACT DENTAL
Active
Other names
Upper Tract Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LISA D MALLOW (OFFICE MANAGER)
(304) 358-8152
Entity
Organization
Contact information
Practice address
9030 PETERSBURG PIKE, UPPER TRACT, WV 26866-8014
(304) 358-7200
(304) 358-7284
Mailing address
8791 PETERSBURG PIKE, UPPER TRACT, WV 26866-8016
(304) 358-8152
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/31/2023
Last updated
08/03/2023
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