Provider Demographics
NPI:1548429160
Name:MALBIS PARKWAY PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MALBIS PARKWAY PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-626-9924
Mailing Address - Street 1:30888 PINE CT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-8668
Mailing Address - Country:US
Mailing Address - Phone:251-626-9924
Mailing Address - Fax:251-626-9984
Practice Address - Street 1:9807 MCSARA COURT
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36527-8668
Practice Address - Country:US
Practice Address - Phone:251-626-9924
Practice Address - Fax:251-626-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty