Provider Demographics
NPI:1225124225
Name:MALAN, MATTHEW WENDALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WENDALL
Last Name:MALAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 JACKSON AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1956
Mailing Address - Country:US
Mailing Address - Phone:801-627-0410
Mailing Address - Fax:801-627-0419
Practice Address - Street 1:3860 JACKSON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1956
Practice Address - Country:US
Practice Address - Phone:801-627-0410
Practice Address - Fax:801-627-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT533491699221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice