Provider Demographics
NPI:1902169170
Name:ADLER, MALLORY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:M
Last Name:ADLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:J
Other - Last Name:MANDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7997 KENILWORTH LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5123
Mailing Address - Country:US
Mailing Address - Phone:513-205-5773
Mailing Address - Fax:
Practice Address - Street 1:9346 TOWNE SQUARE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6943
Practice Address - Country:US
Practice Address - Phone:513-793-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300237481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice