Individual
DR. STEPHEN C MALLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8791 PETERSBUG PIKE, UPPER TRACT, WV 26866-8016
(304) 358-7200
(304) 358-7284
Mailing address
8791 PETERSBUG PIKE, UPPER TRACT, WV 26866-8016
(304) 358-7200
(304) 358-7284
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2529
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136526000
—
WV
Enumeration date
09/20/2006
Last updated
08/19/2015
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