Organization
MARK J MALY ESTATE
Active
Other names
MARK MALY DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY BOSE (OFFICE MANAGER)
(815) 789-4611
Entity
Organization
Contact information
Practice address
103 S MAIN ST # PO, ORANGEVILLE, IL 61060-9244
(815) 789-4611
Mailing address
PO BOX 456, ORANGEVILLE, IL 61060-0456
(815) 789-4611
(815) 789-4612
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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