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General NPI Number Information
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NPI Number | 1437503364
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Entity Type | Individual
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Provider Name | MALLORY JO NYENHUIS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 223 N SAN FRANCISCO ST STE 104
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4657
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Country | US
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Telephone | 928-275-1252
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Fax |
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Provider Business Mailing Address
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Address Line | 2756 W HIGHLAND MEADOWS DR
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City | WILLIAMS
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State | AZ
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Zip | 86046-9179
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Country | US
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Telephone | 920-918-0843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D011313
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License Number State | AZ
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