Individual
MALLORY EDMONDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSDH, RDH
Contact information
Practice address
1002 S ESTHER ST, SOUTH BEND, IN 46615-1440
(219) 363-8866
Mailing address
4511 N 600 E, ROLLING PRAIRIE, IN 46371-9511
(219) 363-8866
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13007311A
IN
Other
Enumeration date
11/03/2018
Last updated
11/03/2018
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