Provider Demographics
NPI:1104912237
Name:MALLORY, DANIEL C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:MALLORY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 SOUTH FM 51
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3771
Mailing Address - Country:US
Mailing Address - Phone:940-627-0960
Mailing Address - Fax:
Practice Address - Street 1:2250 SOUTH FM 51
Practice Address - Street 2:SUITE 800
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3771
Practice Address - Country:US
Practice Address - Phone:940-627-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics