Heather Anne Mallory-May, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15089 Issued in MI

Practice address

2351 Countrywood Dr SE
Suite a
Kentwood, MI 49508-5065

Phone

(616) 455-0720

Fax

(616) 455-0815

NPI assigned

Jul 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Heather Anne Mallory Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215959564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 BRETON CREEK CT SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129088",
            "telephone_number": "616-954-9899",
            "fax_number": "616-455-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2351 COUNTRYWOOD DR SE",
            "address_2": "SUITE A",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085065",
            "telephone_number": "616-455-0720",
            "fax_number": "616-455-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY-MAY",
        "first_name": "HEATHER",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "15089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3142313",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "J150530",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "MALLORY",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• General Practice Dentistry in Kentwood, MI
• Providers in Kentwood, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.