Provider Demographics
NPI:1376791715
Name:MALMQUIST, MICHAEL PRESTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PRESTON
Last Name:MALMQUIST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5106
Mailing Address - Country:US
Mailing Address - Phone:781-388-0900
Mailing Address - Fax:
Practice Address - Street 1:7 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5106
Practice Address - Country:US
Practice Address - Phone:781-388-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist