Healthcare Provider Details

I. General information

NPI: 1477475739
Provider Name (Legal Business Name): NICHOLAS PAUL MALINOWSKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 CLEARVIEW CHURCH LN
LYLES TN
37098-1674
US

IV. Provider business mailing address

7723 CLEARVIEW CHURCH LN
LYLES TN
37098-1674
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-5520
  • Fax:
Mailing address:
  • Phone: 931-670-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13157
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: