Individual
NICHOLAS TALBERT MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
133 W CENTRAL AVE, EAGAR, AZ 85925
(928) 333-4121
Mailing address
150 N RIVER RD, EAGAR, AZ 85925-9899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D010324
AZ
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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