MEDICARE: DR. COLIN A. MALAKER, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	2004007387	MO

General Provider Information

NPI Number	:	1679748453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. COLIN A. MALAKER, DDS, PC

Provider Business Mailing Address
First Line	:	3408 BUTTONWOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3718
Country	:	US
Telephone Number	:	573-256-7891
Fax Number	:	573-256-8002

Provider Business Practice Location Address
First Line	:	3408 BUTTONWOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-3718
Country	:	US
Telephone Number	:	573-256-7891
Fax Number	:	573-256-8002

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. COLIN ANDREW MALAKER
Credential	:	DDS, PC
Telephone Number	:	573-256-7891

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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