Mallott Family Dental, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2003102136 Issued in MO

Legal business name

MALLOTT FAMILY DENTAL, INC.

Practice address

3320 Bluff Creek Dr
Suite 100
Columbia, MO 65201-3501

Phone

(573) 875-5336

NPI assigned

Jun 17, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Johnathan L Mallott, D.D.S.NPI 1730260738

Title

President

Phone

(573) 875-5336

Specialties & licenses 1

Addresses

Other names 1

• Keen Dental Care Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johnathan Lewis Mallott, DDS

  • Dentist
  • Columbia, MO
  • NPI 1730260738
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434499200000",
    "number": "1457732208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 BLUFF CREEK DR",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013501",
            "telephone_number": "573-875-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 BLUFF CREEK DR",
            "address_2": "SUITE 100",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652013501",
            "telephone_number": "573-875-5336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLOTT FAMILY DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2015-06-17",
        "status": "A",
        "authorized_official_last_name": "MALLOTT",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-875-5336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2003102136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keen Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaya Lalitha Mallela, MS
• Rachel Mallett, RN, FNP-BC, MSN
• Hanna Mallien, MD
• Emma L Mallory, NP-C
• Marcus Mallory, PHARMD
• Johnathan Lewis Mallott, DDS
• Elizabeth Ashiokor Malm-Buatsi, M.D.
• Lynn Maloney, L.AC.
• Cayla Leigh Malter, MSW, LCSW
• Crystal Izella Maltsbarger, C.R.N.A.

• General Practice Dentistry in Columbia, MO
• Providers in Columbia, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.