Individual
CHARLES BRENT MALLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8000 BONHOMME AVE STE 401, SUITE 401, CLAYTON, MO 63105-3515
(314) 727-2288
(314) 727-2285
Mailing address
8000 BONHOMME AVE STE 401, SUITE 401, CLAYTON, MO 63105-3515
(314) 727-2288
(314) 727-2285
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11962
MO
Other
Enumeration date
08/11/2007
Last updated
08/11/2007
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