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Individual

ALEC PAUL MALY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
900 N TYLER RD STE 2, WICHITA, KS 67212-3249
(316) 722-2596
Mailing address
10119 W WESTPORT ST, WICHITA, KS 67212-6714
(316) 303-2629

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61897
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
61897
STATE LICENSE
KS
Enumeration date
06/20/2022
Last updated
06/20/2022
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