Individual
DR. JOHNATHAN LEWIS MALLOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3320 BLUFF CREEK DR., SUITE 100, COLUMBIA, MO 65201
(573) 874-2433
(573) 442-6525
Mailing address
3320 BLUFF CREEK DR., SUITE 100, COLUMBIA, MO 65201
(573) 874-2433
(573) 442-6525
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2003012136
MO
Other
Enumeration date
10/17/2006
Last updated
12/21/2021
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