Nicholas Talbert Mallory, DMD
Individual provider Active NPI General Practice Dentistry · Eagar, AZ
NPI 1851950588 · NPPES record last updated Jun 6, 2019
Key facts
- NPI
- 1851950588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D010324 (AZ)
- Practice address
- 133 W Central Ave
Eagar, AZ 85925 - Phone
- (928) 333-4121
- NPI assigned
- Jun 6, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D010324 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jim W Crosby DDS PC | Past | Accepting new patients | |
| Nicholas T Mallory DMD PLLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D010324 | AZ | Yes |
Addresses
Primary practice location
133 W Central Ave
Eagar, AZ 85925
Mailing address
150 N River Rd
Eagar, AZ 85925-9899
Other practice location 1
932 S Main St Ste C
Snowflake, AZ 85937-5585
Phone (928) 536-5773
Other practice location 2
43 W White Mountain Blvd
Lakeside, AZ 85929-7002
Phone (928) 367-9967
Other providers in Eagar, AZ
- James Heap
- Steven Paul Heap
- Christine Jackson
- Jim W Crosby DDS PC
- La Casa Serena
- Candice Marissa Matthews
- Brooke Arlene McCarthy
- Winslow James McNeill
- Nazcare, Inc Power Recovery Center
- Nazcare, Inc.
All providers in Eagar, AZ · General Practice Dentistry in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.