Provider Demographics
NPI:1699966457
Name:JACK L MALVIN DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:JACK L MALVIN DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-661-7316
Mailing Address - Street 1:242 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3937
Mailing Address - Country:US
Mailing Address - Phone:412-661-7316
Mailing Address - Fax:412-661-5903
Practice Address - Street 1:242 S HIGHLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3937
Practice Address - Country:US
Practice Address - Phone:412-661-7316
Practice Address - Fax:412-661-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0206411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty