Bradley James Malley, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

3801-15 Issued in MS

Practice address

11 Lakeland Cir
Jackson, MS 39216-5006

Phone

(601) 981-8166

Fax

(601) 362-2164

NPI assigned

Jun 17, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Malley Dental, PLLC

  • Dentist
  • Jackson, MS
  • NPI 1750077103
  NPD Authorized official
• Lakeland Dental Care PA

  • General Practice Dentistry
  • Jackson, MS
  • NPI 1235441353
  NPD (past)

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1255712923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 LAKELAND CIR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165006",
            "telephone_number": "601-981-8166",
            "fax_number": "601-362-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 LAKELAND CIR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165006",
            "telephone_number": "601-981-8166",
            "fax_number": "601-362-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLEY",
        "first_name": "BRADLEY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-17",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3801-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaquita A Mallett, LCSW
• Andrew Currier Mallette, M.D.
• Kathryn Hollis Mallette, M.D.
• Robert A Mallette, M.D.
• Malley Dental, PLLC
• Priya Reddy Mallimala, M.B.B.S
• Cassandra Malone
• Thomas Malone Jr., LMSW
• Virginia Henley Malone
• Ojus Malphurs

• Dentist in Jackson, MS
• Providers in Jackson, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.