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NPI Code Detail

MEDICARE: HANS MALMSTROM D.D.S.

MEDICARE: HANS MALMSTROM D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry044097NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17165OTHERBLUE SHIELD GROUP NUMBER

General Provider Information

NPI Number : 1366550881
Entity Type Code : Individual
Provider Name (Legal Business Name) : HANS MALMSTROM D.D.S.
Provider Business Mailing Address
First Line : 625 ELMWOOD AVE
Second Line : BOX 683
City : ROCHESTER
State : NY
Zip : 14620-2913
Country : US
Telephone Number : 585-275-5087
Fax Number : 585-276-0293
Provider Business Practice Location Address
First Line : 625 ELMWOOD AVE
Second Line : BOX 683
City : ROCHESTER
State : NY
Zip : 14620-2913
Country : US
Telephone Number : 585-275-5087
Fax Number : 585-276-0293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 03/08/2016

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