Organization
BEVIN K MALLE DDS PA II
Active
Other names
Carolin Kids Dentistry 2
Organization subpart
No
Provider details
NPI number
Authorized official
BEVIN KILEY MALLEY DDS (OWNER/DENTIST)
(704) 883-4624
Entity
Organization
Contact information
Practice address
9817 SUZANNE CT., SUITE B, WAXHAW, NC 28173-8848
(980) 339-8730
(704) 790-0593
Mailing address
3900 WINDWOOD CIRCLE, CHARLOTTE, NC 28226-7928
(704) 790-0590
(704) 790-0593
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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