Healthcare Provider Details

I. General information

NPI: 1861320475
Provider Name (Legal Business Name): MDG ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WAREHAM RD
MARION MA
02738-1167
US

IV. Provider business mailing address

140 WAREHAM RD
MARION MA
02738-1167
US

V. Phone/Fax

Practice location:
  • Phone: 508-500-4151
  • Fax:
Mailing address:
  • Phone: 508-500-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SABINA MALLA
Title or Position: OWNER AND DENTAL DIRECTOR
Credential: DDS
Phone: 971-275-5583