CHARLES BRENT MALLIN (NPI# 1750573960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1750573960 |
Entity Type | Individual |
Full Name | CHARLES BRENT MALLIN |
Credential | D.D.S. |
Practice Address |
8000 Bonhomme Ave Ste 401 Suite 401 Clayton MO 63105-3515 |
Practice Telephone | 3147272288 |
Practice Fax Number | 3147272285 |
Mailing Telephone | 3147272288 |
Mailing Fax Number | 3147272285 |
Enumeration Date | 2007-08-11 |
Last Update Date | 2007-08-11 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223G0001X |
Dentist Specialization: General Practice |
11962 | MO | Dental Providers |
Street Address |
8000 BONHOMME AVE STE 401 SUITE 401 |
City | CLAYTON |
State | MO |
Zip Code | 63105-3515 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861016545 | Amy Piontek | Registered Nurse | Habif Health and Wellness Center, 6643 Shepley Drive, St. Louis, MO 63105 | 2020-05-29 |
1427520634 | Justin Kelly | Chiropractor | 8011 Maryland Avenue, St. Louis, MO 63105 | 2018-12-28 |
1720576663 | St. Louis Center for Cognitive Health, LLC | Clinic/Center | 7711 Bonhomme Ave Ste 350, Clayton, MO 63105 | 2018-04-26 |
1457849317 | A Storied Life Counseling LLC | Social Worker | 8000 Bonhomme Ave Ste 321, Clayton, MO 63105 | 2018-04-26 |
1669984142 | Peter Bogart | Counselor | 7710 Carondelet, Suite #204, Saint Louis, MO 63105 | 2017-10-24 |
1356891162 | Medical West Respiratory Pharmacy, LLC | Pharmacy | 440 South Brentwood Blvd, Clayton, MO 63105 | 2016-10-05 |
1710435565 | James Breihan | Occupational Therapist | 401 Corporate Park Drive, Clayton, MO 63105 | 2016-09-21 |
1730566928 | Frank Theus | Counselor | 7710 Carondelet Ave Ste 220, Saint Louis, MO 63105 | 2015-04-27 |
1962895896 | John B Martin | Obstetrics & Gynecology | 312 N. Meramec #300, St. Louis, MO 63105 | 2015-03-17 |
1861814261 | Jesse Marie Civello | Physical Therapist | 222 S Meramec Avenue, Suite 100, Clayton, MO 63105 | 2014-01-20 |
Find all providers in zip 63105 |
Taxonomy Code | 1223G0001X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | General Practice |
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
Notes: Source: Academy of General Dentistry |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326577602 | Matthew Barnes | Dentist | 660 Nc-42, Clayton, NC 27520 | 2017-06-08 |
1790231231 | Debra Peterson | Dentist | 32 Atchinson Stage Ct, Clayton, CA 94517-1101 | 2016-08-25 |
1831447259 | David P. Cartago Dds, Dental Office, Inc. | Dentist | 1026 Oak St Ste 202, Clayton, CA 94517-1363 | 2012-08-15 |
1578824488 | Matthew J Grabowski | Dentist | 100 Pinecroft Dr, Clayton, NC 27520-6923 | 2012-06-06 |
1053683979 | Stephanie Lynn Brown | Dentist | 964 Nc Highway 42 W, Clayton, NC 27520-7434 | 2012-02-08 |
1295029163 | Victor Duc Truong | Dentist | 6200 Center St, Suite I, Clayton, CA 94517-1446 | 2011-06-08 |
1598961690 | John Clifford Tomasheski | Dentist | 31 Oleander Dr, Clayton, NC 27527-4561 | 2007-06-25 |
1275672875 | Wesley Turner Funk | Dentist | 608 Highway 76 West, Clayton, GA 30525-0031 | 2007-02-06 |
1245382936 | Jason Wayne Mullen | Dentist | 100 Pinecroft Dr., Clayton, NC 27520 | 2007-01-16 |
1194801852 | Riccobene Flowers | Dentist | 31 Oleander Drive, Clayton, NC 27527 | 2006-10-27 |
Find all providers in CLAYTON |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.