Provider Demographics
NPI:1215039292
Name:DENNY L MALCOM DDS PC
Entity Type:Organization
Organization Name:DENNY L MALCOM DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-464-2636
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-0443
Mailing Address - Country:US
Mailing Address - Phone:770-464-2636
Mailing Address - Fax:770-464-2636
Practice Address - Street 1:133 CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-0443
Practice Address - Country:US
Practice Address - Phone:770-464-2636
Practice Address - Fax:770-464-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty