Provider Demographics
NPI:1356359004
Name:MALLEY, BEVIN KILEY (DDS)
Entity type:Individual
Prefix:DR
First Name:BEVIN
Middle Name:KILEY
Last Name:MALLEY
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 1:360 S ELM ST
Mailing Address - Street 2:UNIT 310
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2774
Mailing Address - Country:US
Mailing Address - Phone:614-638-0218
Mailing Address - Fax:
Practice Address - Street 1:5408 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4367
Practice Address - Country:US
Practice Address - Phone:336-292-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211761223G0001X
NC82381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry