Individual
MALLARY N ST. JOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205
(614) 722-2207
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
30025062
OH
1223P0221X
Pediatric Dentistry
Primary
30025062
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0276116
—
OH
Enumeration date
02/08/2017
Last updated
07/24/2018
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