Healthcare Provider Details

I. General information

NPI: 1669558698
Provider Name (Legal Business Name): JEFFREY MALMQUIST DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 AMHERST ST STE 8
NASHUA NH
03063-1216
US

IV. Provider business mailing address

17 KING GEORGE DR
LONDONDERRY NH
03053-2817
US

V. Phone/Fax

Practice location:
  • Phone: 603-717-3500
  • Fax:
Mailing address:
  • Phone: 781-420-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04637
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21161
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: