Organization
BEVIN K MALLEY DDS PA
Active
Other names
Carolina Kids Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEVIN KILEY MALLEY D.D.S. (PEDIATRIC DENTIST)
(704) 790-0590
Entity
Organization
Contact information
Practice address
6918 GARDEN TERRACE CT, CHARLOTTE, NC 28210-2706
(704) 790-0590
(704) 790-0593
Mailing address
6918 GARDEN TERRACE CT, CHARLOTTE, NC 28210-2706
(704) 790-0590
(704) 790-0593
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8238
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356359004
INDIVIDUAL NPI
NC
05
—
5906.301
—
NC
Enumeration date
09/21/2010
Last updated
09/21/2010
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