Provider Demographics
NPI:1215916663
Name:MALLEY, MICHAEL JAMES (DDS MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MALLEY
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:J
Other - Last Name:MALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS MS PC
Mailing Address - Street 1:2425 WEST WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838
Mailing Address - Country:US
Mailing Address - Phone:616-754-2274
Mailing Address - Fax:616-754-8886
Practice Address - Street 1:2425 WEST WASHINGTON
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-754-2274
Practice Address - Fax:616-754-8886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI290156621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice