Individual
DR. SHIBLY D MALOUF JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
366 BROADWAY, SUITE 100, SOMERVILLE, MA 02145-2812
(617) 628-8000
(617) 628-2370
Mailing address
366 BROADWAY SUITE 100, SOMERVILLE, MA 02145-2812
(617) 628-8000
(617) 628-2370
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9637
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009637
TUFTS
—
05
—
0223573
—
MA
01
—
Y03044
BS
MA
Enumeration date
12/01/2006
Last updated
07/08/2007
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