Provider Demographics
NPI:1679748453
Name:DR. COLIN A. MALAKER, DDS, PC
Entity type:Organization
Organization Name:DR. COLIN A. MALAKER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MALAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:573-256-7891
Mailing Address - Street 1:3408 BUTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3718
Mailing Address - Country:US
Mailing Address - Phone:573-256-7891
Mailing Address - Fax:573-256-8002
Practice Address - Street 1:3408 BUTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3718
Practice Address - Country:US
Practice Address - Phone:573-256-7891
Practice Address - Fax:573-256-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004007387261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental