Provider Demographics
NPI:1770755704
Name:MAGED A. EL-MALECKI
Entity type:Organization
Organization Name:MAGED A. EL-MALECKI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL-MALECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-548-8003
Mailing Address - Street 1:134 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5869
Mailing Address - Country:US
Mailing Address - Phone:978-342-0225
Mailing Address - Fax:978-342-3001
Practice Address - Street 1:134 SUMMER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5869
Practice Address - Country:US
Practice Address - Phone:978-342-0225
Practice Address - Fax:978-342-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206341223E0200X
MA215941223G0001X
MA207581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty