Provider Demographics
NPI:1164913760
Name:SHEALER, MALCOLM LAMAR (DDS, MHS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:LAMAR
Last Name:SHEALER
Suffix:
Gender:M
Credentials:DDS, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NOVALIS ST
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-1066
Mailing Address - Country:US
Mailing Address - Phone:540-877-7672
Mailing Address - Fax:
Practice Address - Street 1:4816 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-3253
Practice Address - Country:US
Practice Address - Phone:615-610-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
TN107891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program