Provider Demographics
NPI:1891817052
Name:MALLOUH, ABBOUD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBOUD
Middle Name:
Last Name:MALLOUH
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 1:30 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1359
Mailing Address - Country:US
Mailing Address - Phone:617-680-0329
Mailing Address - Fax:
Practice Address - Street 1:50 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3540
Practice Address - Country:US
Practice Address - Phone:508-792-2991
Practice Address - Fax:508-799-7681
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist