Mallory Therese Still, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901021950 Issued in MI

Practice address

319 W Main St
Flushing, MI 48433-2033

Phone

(810) 659-7800

NPI assigned

Jul 20, 2016

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 names 1

• Dr. Mallory Therese Lukas Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

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

{
    "created_epoch": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1518310911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 N MAIN ST",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483461518",
            "telephone_number": "734-716-9233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W MAIN ST",
            "city": "FLUSHING",
            "state": "MI",
            "postal_code": "484332033",
            "telephone_number": "810-659-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STILL",
        "first_name": "MALLORY",
        "middle_name": "THERESE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-20",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "LUKAS",
            "middle_name": "THERESE",
            "prefix": "DR.",
            "credential": "MALLORY LUKAS DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dentist in Flushing, MI
• Providers in Flushing, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.