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General NPI Number Information
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NPI Number | 1023326287
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Entity Type | Organization
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Legal Business Name | BEVIN K MALLEY DDS PA
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Dates
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Enumeration Date | 09/21/2010
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 6918 GARDEN TERRACE CT
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City | CHARLOTTE
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State | NC
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Zip | 28210-2706
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Country | US
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Telephone | 704-790-0590
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Fax | 704-790-0593
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Provider Business Mailing Address
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Address Line | 6918 GARDEN TERRACE CT
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City | CHARLOTTE
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State | NC
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Zip | 28210-2706
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Country | US
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Telephone | 704-790-0590
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Fax | 704-790-0593
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. BEVIN KILEY MALLEY
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Credential | D.D.S.
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Telephone | 704-790-0590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8238
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License Number State | NC
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