# BEVIN K MALLE DDS PA II

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carolin Kids Dentistry 2
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154981371
- **Authorized official:** BEVIN KILEY MALLEY DDS (OWNER/DENTIST)
- **Authorized official phone:** (704) 883-4624

## Contact information

- **Practice address:** 9817 SUZANNE CT., SUITE B, WAXHAW, NC 28173-8848
- **Practice address phone:** (980) 339-8730
- **Practice address fax:** (704) 790-0593
- **Mailing address:** 3900 WINDWOOD CIRCLE, CHARLOTTE, NC 28226-7928
- **Mailing address phone:** (704) 790-0590
- **Mailing address fax:** (704) 790-0593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |

## Other

- **Enumeration date:** 06/19/2019
- **Last updated:** 06/19/2019