Provider Demographics
NPI:1710385653
Name:MALAMENT, MARIAM (DMD, MSC, PHD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:MALAMENT
Suffix:
Gender:F
Credentials:DMD, MSC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST FL 5
Mailing Address - Street 2:BOSTON PROSTHODONTICS
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-523-5451
Mailing Address - Fax:617-636-6583
Practice Address - Street 1:1 KNEELAND ST.
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:617-636-2436
Practice Address - Fax:617-636-6583
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12259122300000X
MADN1859500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist