Individual
DR. SUSAN REGINA MALLERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
305 W 12TH AVE, COLLEGE OF DENTISTRY OHIO STATE UNIVERSITY, COLUMBUS, OH 43210-1267
(614) 292-5892
(614) 292-9384
Mailing address
305 W 12TH AVE, COLLEGE OF DENTISTRY OHIO STATE UNIVERSITY, COLUMBUS, OH 43210-1267
(614) 292-5892
(614) 292-9384
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
30016966
OH
Other
Enumeration date
02/16/2006
Last updated
03/08/2012
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