Provider Demographics
NPI:1285376285
Name:CHRISTOPHER M. MALLOW DDS, PC
Entity type:Organization
Organization Name:CHRISTOPHER M. MALLOW DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-486-3379
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:BLISSFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49228-0098
Mailing Address - Country:US
Mailing Address - Phone:517-486-3379
Mailing Address - Fax:517-486-4635
Practice Address - Street 1:105 GILES AVE
Practice Address - Street 2:
Practice Address - City:BLISSFIELD
Practice Address - State:MI
Practice Address - Zip Code:49228-1238
Practice Address - Country:US
Practice Address - Phone:517-486-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental