Organization
RICHARD J SORBERA DDS SHILBY D MALOUF DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHILBY D MALOUF JR. DDS (VICE PRESIDENT)
(617) 628-8000
Entity
Organization
Contact information
Practice address
366 BROADWAY, SOMERVILLE, MA 01245-2812
(617) 628-8000
(617) 628-2370
Mailing address
366 BROADWAY, SOMERVILLE, MA 01245-2812
(617) 628-8000
(617) 628-2370
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
9458
MA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
9637
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0202061
—
MA
05
—
0223573
—
MA
01
—
X03044
RS
MA
01
—
X03159
RS
MA
Enumeration date
11/22/2006
Last updated
08/22/2020
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