Kermit J Mallette, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012289 Issued in GA

Practice address

201 Crosstown Dr Apt 1020
Peachtree City, GA 30269-3457

Phone

(228) 547-5977

NPI assigned

May 28, 2008

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266796800000",
    "number": "1750549549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CROSSTOWN DR APT 1020",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693457",
            "telephone_number": "228-547-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CROSSTOWN DR APT 1020",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693457",
            "telephone_number": "228-547-5977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLETTE",
        "first_name": "KERMIT",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-28",
        "last_updated": "2010-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahima Dental LLC (Aesthetic Restorative Dentistry)
• Main Element Counseling
• Nancy Mainelli-Langer
• Alisha Mainor
• Siarra Aderonke Maketo, LCSW
• Cris Malloy
• Anisha Mandava, M.D
• Kimberley S. Mapel, LPC
• Joel Marcellino
• Laura Marchese, R.D.N., L.D.

• General Practice Dentistry in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; 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.