Individual
DR. JENNI MARIE O'MALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
1105 W STONE DR STE 5, KINGSPORT, TN 37660-2558
(423) 224-5697
Mailing address
1374 CATTAIL PT, JOHNSON CITY, TN 37601-9404
(407) 791-7997
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
11246
TN
122300000X
Dentist
21809
FL
122300000X
Dentist
27456
TX
122300000X
Dentist
Primary
8896
SC
1223G0001X
General Practice Dentistry
27456
TX
Other
Enumeration date
12/01/2011
Last updated
10/27/2021
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