Provider Demographics
NPI:1346939089
Name:LANFORD, MALLORY (DMD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:LANFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:MATHIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6807 TATTERSALL WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4237
Mailing Address - Country:US
Mailing Address - Phone:205-508-9523
Mailing Address - Fax:
Practice Address - Street 1:6807 TATTERSALL WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4237
Practice Address - Country:US
Practice Address - Phone:205-508-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007309-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice