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General NPI Number Information
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NPI Number | 1154981371
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Entity Type | Organization
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Legal Business Name | BEVIN K MALLE DDS PA II
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 9817 SUZANNE CT. SUITE B
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City | WAXHAW
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State | NC
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Zip | 28173-8848
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Country | US
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Telephone | 980-339-8730
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Fax | 704-790-0593
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Provider Business Mailing Address
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Address Line | 3900 WINDWOOD CIRCLE
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City | CHARLOTTE
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State | NC
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Zip | 28226-7928
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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 | OWNER/DENTIST
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Name | BEVIN KILEY MALLEY
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Credential | DDS
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Telephone | 704-883-4624
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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