MEDICARE: MALBIS PARKWAY PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry	5534	AL

General Provider Information

NPI Number	:	1548429160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALBIS PARKWAY PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	30888 PINE CT
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-8668
Country	:	US
Telephone Number	:	251-626-9924
Fax Number	:	251-626-9984

Provider Business Practice Location Address
First Line	:	9807 MCSARA COURT
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36527-8668
Country	:	US
Telephone Number	:	251-626-9924
Fax Number	:	251-626-9984

Authorized Official
Title or Position	:	PEDIATRIC DENTIST/OWNER
Name	:	DR. KELLY M JONES
Credential	:	DMD
Telephone Number	:	251-626-9924

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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