Mallard Creek Family Dentistry LLP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MALLARD CREEK FAMILY DENTISTRY LLP

Practice address

3010 Baucom Rd Ste 200
Charlotte, NC 28269-6765

Phone

(704) 596-0021

Fax

(704) 599-1155

NPI assigned

Oct 11, 2019

Organization subpart

No

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

Authorized official

Name

Suzi Wallace

Title

Practice Administrator

Phone

(704) 596-0021

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1306488382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 BAUCOM RD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282696765",
            "telephone_number": "704-596-0021",
            "fax_number": "704-599-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 BAUCOM RD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282696765",
            "telephone_number": "704-596-0021",
            "fax_number": "704-599-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALLARD CREEK FAMILY DENTISTRY LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SUZI",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-596-0021"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dena Marie Malia, OTR/L
• Emma Grace Malinowski, LCSWA
• Karen Leigh Malizia
• Meghan H Malka, RD
• Mallard Creek Chiropractic Group
• Mallard Creek Learning Center
• Mallard Creek Therapeutic Services
• Michelle Parker Mallen, M.S, CCC-SLP
• Michelle Mallery Patel, BS
• Anna Catherine Malles, LCSWA

• General Practice Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.