Provider Demographics
NPI:1598938334
Name:MALAN, MATTHEW JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JEREMY
Last Name:MALAN
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 1:221 W FIR AVE
Mailing Address - Street 2:STE. 108
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0221
Mailing Address - Country:US
Mailing Address - Phone:559-325-8448
Mailing Address - Fax:559-325-8447
Practice Address - Street 1:221 W FIR AVE
Practice Address - Street 2:STE. 108
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0221
Practice Address - Country:US
Practice Address - Phone:559-325-8448
Practice Address - Fax:559-325-8447
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice