Provider Demographics
NPI:1245496884
Name:MALAN, DANIEL S (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:MALAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 E GOWEN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716
Mailing Address - Country:US
Mailing Address - Phone:208-407-4129
Mailing Address - Fax:208-338-8964
Practice Address - Street 1:2398 E GOWEN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6707
Practice Address - Country:US
Practice Address - Phone:208-345-1751
Practice Address - Fax:208-338-8964
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD40631223G0001X
IDD-40631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice