NPI 1467920892

Mallory Edmondson, MSDHRDH

Practitioner Dental Hygienist South Bend, IN

Practice location

Address: 1002 S Esther St, South Bend, IN 46615-1440
Phone: (219) 363-8866
Mailing address: 4511 N 600 E, Rolling Prairie, IN 46371-9511

Registered specialties

Dental Hygienist Primary

Dental Providers Taxonomy 124Q00000X Licence 13007311A (IN)

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Registry record

NPI: 1467920892
Entity type: Individual
Sex (as registered): Female
NPI issued: 3 Nov 2018
Record last updated: 3 Nov 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.