Provider Demographics
NPI:1871765420
Name:CHARLES W. MALTA, D.D.S., P.C.
Entity type:Organization
Organization Name:CHARLES W. MALTA, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MALTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-438-5200
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1619
Mailing Address - Country:US
Mailing Address - Phone:781-438-5200
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1619
Practice Address - Country:US
Practice Address - Phone:781-438-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty