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General NPI Number Information
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NPI Number | 1841400462
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Entity Type | Organization
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Legal Business Name | MALCHOW & LAWLESS ORTHODONTICS PSC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 03/16/2009
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Provider Practice Location Address
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Address Line | 895 WILKINSON TRCE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-2486
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Country | US
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Telephone | 270-781-1025
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Fax | 270-781-8707
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Provider Business Mailing Address
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Address Line | 895 WILKINSON TRCE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-2486
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Country | US
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Telephone | 270-781-1025
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Fax | 270-781-8707
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JONATHAN J LAWLESS
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Credential | DMD
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Telephone | 270-781-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4133
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License Number State | KY
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