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NICHOLAS TALBERT MALLORY DMD

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1851950588

Individual Registrant:
 NICHOLAS TALBERT MALLORY DMD
Gender: M
Sole Proprietor

Location and contact information for practice:
133 W CENTRAL AVE  EAGAR, AZ 85925 US
Tel: 928-333-4121  Fax: --

Contact information for business:
150 N RIVER RD  EAGAR, AZ 85925-9899 US
Tel: --  Fax: --

Registration Information:
NPI: 1851950588
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
AZD010324

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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