Stephen C Mallow, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2529 Issued in WV

Practice address

8791 Petersbug Pike
Upper Tract, WV 26866-8016

Phone

(304) 358-7200

Fax

(304) 358-7284

NPI assigned

Sep 20, 2006

Last updated

Aug 19, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Stephen C Mallow Dba Upper Tract Dental

  dba Upper Tract Dental

  • General Practice Dentistry
  • Upper Tract, WV
  • NPI 1083395081
  NPD

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439942400000",
    "number": "1720185523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8791 PETERSBUG PIKE",
            "city": "UPPER TRACT",
            "state": "WV",
            "postal_code": "268668016",
            "telephone_number": "304-358-7200",
            "fax_number": "304-358-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8791 PETERSBUG PIKE",
            "city": "UPPER TRACT",
            "state": "WV",
            "postal_code": "268668016",
            "telephone_number": "304-358-7200",
            "fax_number": "304-358-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOW",
        "first_name": "STEPHEN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "2529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Hottinger
• Nichole Johnson
• Mary S Kimble
• Christopher Stephen Mallow, DDS
• Siera Mallow, DDS
• Teresa Mowery
• Shelia Propst
• Armeda Faye Ryder
• Delores Shirk
• Rebecca Sly

• Dentist in Upper Tract, WV
• Providers in Upper Tract, WV by specialty
• Dentist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.