Organization
MALLOTT FAMILY DENTAL, INC.
Active
Other names
Keen Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNATHAN L MALLOTT D.D.S. (PRESIDENT)
(573) 875-5336
Entity
Organization
Contact information
Practice address
3320 BLUFF CREEK DR, SUITE 100, COLUMBIA, MO 65201-3501
(573) 875-5336
Mailing address
3320 BLUFF CREEK DR, SUITE 100, COLUMBIA, MO 65201-3501
(573) 875-5336
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2003102136
MO
Other
Enumeration date
06/17/2015
Last updated
06/17/2015
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