Individual
DR. MALLORY JANE HACKBARTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
105 BEN CASEY DR STE 121, FORT MILL, SC 29708-8574
(803) 802-3681
Mailing address
105 BEN CASEY DR STE 121, FORT MILL, SC 29708-8574
(803) 802-3681
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
10831
SC
1223G0001X
General Practice Dentistry
10500
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2016
Last updated
12/03/2024
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