Provider Demographics
NPI:1063575033
Name:MALLOY, SHERILYN VICTORIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERILYN
Middle Name:VICTORIA
Last Name:MALLOY
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 1:220 LILLY RD NE
Mailing Address - Street 2:STE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-459-9694
Mailing Address - Fax:360-459-9657
Practice Address - Street 1:220 LILLY RD NE
Practice Address - Street 2:STE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-459-9694
Practice Address - Fax:360-459-9657
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6693122300000X
CA27724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist