Provider Demographics
NPI:1588671325
Name:K'MALI, LANCY ANTONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCY
Middle Name:ANTONY
Last Name:K'MALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1370
Mailing Address - Country:US
Mailing Address - Phone:586-792-2653
Mailing Address - Fax:
Practice Address - Street 1:29510 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4136
Practice Address - Country:US
Practice Address - Phone:586-775-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010161871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice