Provider Demographics
NPI:1891809695
Name:MALIN, DAVID MORGAN (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MORGAN
Last Name:MALIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:MORGAN
Other - Last Name:MALIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:343 FRANKLIN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5213
Mailing Address - Country:US
Mailing Address - Phone:615-370-9733
Mailing Address - Fax:615-370-9734
Practice Address - Street 1:343 FRANKLIN ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5250
Practice Address - Country:US
Practice Address - Phone:615-370-9733
Practice Address - Fax:615-370-9734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS21701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0113129OtherBCBS
TN0113129OtherBCBS