Provider Demographics
NPI:1578978318
Name:MALACARNE, ALBERTO (BDS,DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:MALACARNE
Suffix:
Gender:M
Credentials:BDS,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KNEELAND STREET 6TH FLOOR, CRANIOFACIAL PAIN CENTER
Mailing Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6817
Mailing Address - Fax:617-636-3831
Practice Address - Street 1:1 KNEELAND STREET 6TH FLOOR, CRANIOFACIAL PAIN CENTER
Practice Address - Street 2:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6817
Practice Address - Fax:617-636-3831
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-01-26
Deactivation Date:2015-02-06
Deactivation Code:
Reactivation Date:2015-10-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18596631223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program