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General NPI Number Information
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NPI Number | 1548429160
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Entity Type | Organization
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Legal Business Name | MALBIS PARKWAY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 9807 MCSARA COURT
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City | DAPHNE
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State | AL
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Zip | 36527-8668
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Country | US
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Telephone | 251-626-9924
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Fax | 251-626-9984
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Provider Business Mailing Address
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Address Line | 30888 PINE CT
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City | SPANISH FORT
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State | AL
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Zip | 36527-8668
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Country | US
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Telephone | 251-626-9924
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Fax | 251-626-9984
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/OWNER
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Name | DR. KELLY M JONES
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Credential | DMD
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Telephone | 251-626-9924
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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 | 5534
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License Number State | AL
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