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General NPI Number Information
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NPI Number | 1164597217
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Entity Type | Organization
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Legal Business Name | RICHARD J SORBERA DDS SHILBY D MALOUF DDS INC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 366 BROADWAY
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City | SOMERVILLE
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State | MA
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Zip | 01245-2812
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Country | US
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Telephone | 617-628-8000
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Fax | 617-628-2370
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Provider Business Mailing Address
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Address Line | 366 BROADWAY
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City | SOMERVILLE
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State | MA
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Zip | 01245-2812
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Country | US
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Telephone | 617-628-8000
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Fax | 617-628-2370
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. SHILBY D MALOUF JR.
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Credential | DDS
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Telephone | 617-628-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9458
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9637
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License Number State | MA
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