NPIMap

Individual provider Active NPI

Shibly D Malouf Jr., DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Somerville, MA
National Provider Identifier
1053489682
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
9637 Issued in MA
Practice address
366 Broadway
Suite 100
Somerville, MA 02145-2812
Phone
(617) 628-8000
Fax
(617) 628-2370
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 9637 MA Primary

Addresses

Primary practice location

366 Broadway
Suite 100
Somerville, MA 02145-2812

Mailing address

366 Broadway Suite 100
Somerville, MA 02145-2812
Phone (617) 628-8000

Other identifiers 3

IdentifierTypeStateIssuer
Y03044OtherMABS
009637OtherTUFTS
0223573MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9637MAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Richard J Sorbera DDS Shilby D Malouf DDS Inc Oral and Maxillofacial Surgery Past Accepting new patients
C.M.F.-Cranio-Maxillofacial Surgery Associates Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053489682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 BROADWAY SUITE 100",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452812",
            "telephone_number": "617-628-8000",
            "fax_number": "617-628-2370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 BROADWAY",
            "address_2": "SUITE 100",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452812",
            "telephone_number": "617-628-8000",
            "fax_number": "617-628-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALOUF",
        "first_name": "SHIBLY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "9637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "Y03044",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "009637",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0223573",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.