Provider Demographics
NPI:1659588283
Name:MALTSEN, KONSTANTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:MALTSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3823
Mailing Address - Country:US
Mailing Address - Phone:973-661-1020
Mailing Address - Fax:973-661-1012
Practice Address - Street 1:189 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3823
Practice Address - Country:US
Practice Address - Phone:973-661-1020
Practice Address - Fax:973-661-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI227571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics