Healthcare Provider Details

I. General information

NPI: 1649632704
Provider Name (Legal Business Name): MALLORY ANNA ULMER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7028 WRIGHTSVILLE AVE
WILMINGTON NC
28403-3655
US

IV. Provider business mailing address

4106 WAKE FOREST RD STE 100
RALEIGH NC
27609-6397
US

V. Phone/Fax

Practice location:
  • Phone: 910-256-8486
  • Fax:
Mailing address:
  • Phone: 919-876-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9547
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number13510
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: