Provider Demographics
NPI:1003191180
Name:MALWIN & MALWIN FAMILY DENTISTRY PA
Entity type:Organization
Organization Name:MALWIN & MALWIN FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KURK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALWIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:941-488-1459
Mailing Address - Street 1:343 MIAMI AVE W
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2306
Mailing Address - Country:US
Mailing Address - Phone:941-488-1459
Mailing Address - Fax:941-488-0521
Practice Address - Street 1:343 W. MIAMI AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-488-1459
Practice Address - Fax:941-488-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty