Provider Demographics
NPI:1518310911
Name:STILL, MALLORY THERESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:THERESE
Last Name:STILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:THERESE
Other - Last Name:LUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MALLORY LUKAS DDS
Mailing Address - Street 1:122 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1518
Mailing Address - Country:US
Mailing Address - Phone:734-716-9233
Mailing Address - Fax:
Practice Address - Street 1:319 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2033
Practice Address - Country:US
Practice Address - Phone:810-659-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist