Provider Demographics
NPI:1154654796
Name:AL-QALLAF, MASHAEL (BDS)
Entity Type:Individual
Prefix:DR
First Name:MASHAEL
Middle Name:
Last Name:AL-QALLAF
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGHPOINT CIR APT 603
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4652
Mailing Address - Country:US
Mailing Address - Phone:443-825-1823
Mailing Address - Fax:
Practice Address - Street 1:10 HIGHPOINT CIR APT 603
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:443-825-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL 107521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics