Provider Demographics
NPI:1841395076
Name:JOSEPH MALLOUH D.D.S., P.C.
Entity type:Organization
Organization Name:JOSEPH MALLOUH D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:MALLOUH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-792-2991
Mailing Address - Street 1:50 BOSTON TPKE
Mailing Address - Street 2:WHITE CITY SHOPPING CENTER
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3540
Mailing Address - Country:US
Mailing Address - Phone:508-792-2991
Mailing Address - Fax:508-799-7681
Practice Address - Street 1:50 BOSTON TPKE
Practice Address - Street 2:WHITE CITY SHOPPING CENTER
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12069OtherBCBS ID #