Provider Demographics
NPI:1730107194
Name:STEEN, MALCOLM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:STEEN
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 1:154 MCGREGOR RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-8644
Mailing Address - Country:US
Mailing Address - Phone:386-736-9966
Mailing Address - Fax:386-822-9959
Practice Address - Street 1:154 MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-8644
Practice Address - Country:US
Practice Address - Phone:386-736-9966
Practice Address - Fax:386-822-9959
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 65051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics