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General NPI Number Information
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NPI Number | 1770755704
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Entity Type | Organization
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Legal Business Name | MAGED A. EL-MALECKI
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 134 SUMMER ST
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City | FITCHBURG
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State | MA
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Zip | 01420-5869
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Country | US
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Telephone | 978-342-0225
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Fax | 978-342-3001
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Provider Business Mailing Address
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Address Line | 134 SUMMER ST
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City | FITCHBURG
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State | MA
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Zip | 01420-5869
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Country | US
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Telephone | 978-342-0225
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Fax | 978-342-3001
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. MAGED A EL-MALECKI
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Credential | D.M.D.
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Telephone | 617-548-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 20634
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21594
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20758
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License Number State | MA
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