Organization
MALLARD CREEK FAMILY DENTISTRY LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZI WALLACE (PRACTICE ADMINISTRATOR)
(704) 596-0021
Entity
Organization
Contact information
Practice address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Mailing address
3010 BAUCOM RD STE 200, CHARLOTTE, NC 28269-6765
(704) 596-0021
(704) 599-1155
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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