Provider Demographics
NPI:1407939366
Name:KAISER, MALCOLM DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:DEAN
Last Name:KAISER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 E LINCOLN B-108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253
Mailing Address - Country:US
Mailing Address - Phone:489-948-1450
Mailing Address - Fax:
Practice Address - Street 1:7125 E LINCOLN DR # B-108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4429
Practice Address - Country:US
Practice Address - Phone:489-948-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist