Nicholas Talbert Mallory, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010324 Issued in AZ

Practice address

133 W Central Ave
Eagar, AZ 85925

Phone

(928) 333-4121

NPI assigned

Jun 6, 2019

Last updated

Jun 6, 2019By the provider in NPPES

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

Practice roles

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

• Nicholas T Mallory DMD PLLC

  • General Practice Dentistry
  • Eagar, AZ
  • NPI 1053234377
  NPD (past) Authorized official
• Jim W Crosby DDS PC

  • Dentist
  • Eagar, AZ
  • NPI 1730130360
  NPD (past)
• Snowflake Family Dental

  • General Practice Dentistry
  • Snowflake, AZ
  • NPI 1699679209
  NPD (past)

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

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1851950588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N RIVER RD",
            "city": "EAGAR",
            "state": "AZ",
            "postal_code": "859259899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 W CENTRAL AVE",
            "city": "EAGAR",
            "state": "AZ",
            "postal_code": "85925",
            "telephone_number": "928-333-4121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "932 S Main St Ste C",
            "address_purpose": "LOCATION",
            "city": "Snowflake",
            "state": "AZ",
            "postal_code": "859375585",
            "country_code": "US",
            "telephone_number": "928-536-5773",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "43 W White Mountain Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeside",
            "state": "AZ",
            "postal_code": "859297002",
            "country_code": "US",
            "telephone_number": "928-367-9967",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "NICHOLAS",
        "middle_name": "TALBERT",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Heap
• Steven Paul Heap, OD
• Christine Jackson, MD
• Jim W Crosby DDS PC
• La Casa Serena
• Candice Marissa Matthews, RDH
• Brooke Arlene McCarthy, OTRL
• Winslow James McNeill, D.C.
• Nazcare, Inc Power Recovery Center
• Nazcare, Inc.

• General Practice Dentistry in Eagar, AZ
• Providers in Eagar, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.