Jack Daniel Mallette, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DS0000008406 Issued in TN

Practice address

538 Brandies Circle
Suite 102
Murfreesboro, TN 37128

Phone

(615) 494-5487

Fax

(615) 494-4649

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Childrens Dentistry of Murfreesboro PLLC

  • Pediatric Dentistry
  • Murfreesboro, TN
  • NPI 1548463466
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316131200000",
    "number": "1932328317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 BRANDIES CIRCLE",
            "address_2": "SUITE 102",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "37128",
            "telephone_number": "615-494-5487",
            "fax_number": "615-494-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "538 BRANDIES CIRCLE",
            "address_2": "SUITE 102",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "37128",
            "telephone_number": "615-494-5487",
            "fax_number": "615-494-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLETTE",
        "first_name": "JACK",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2011-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "DS0000008406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tifany Lyne Makuch, MSN, WHNP-BC
• Jessica Maldonado
• Mary Kaitlin Malick
• Muhammad Fayaz Malik, MD
• Eliza Echavez Mall, DNP
• James Mallette, OTR/L
• Melinda Beckman Mallette, MD
• Melissa Jane Malley, NP-C
• Katie Marie Mallinger, LCSW
• Madhavi Mallipeddi, MD

• Pediatric Dentistry in Murfreesboro, TN
• Providers in Murfreesboro, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; 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.