Charles M Malkemus, DDS, JD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MA11207 Issued in MA

Practice address

166 Columbia Rd
Dorchester, MA 02121-3411

Phone

(617) 445-9880

Fax

(617) 445-5746

NPI assigned

Aug 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor

State licenses

Practice roles

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

• Dr Charles Malkemus Inc

  • General Practice Dentistry
  • Dorchester, MA
  • NPI 1508977547
  NPD (past) Authorized official
• Cummins Family Dental PC

  • General Practice Dentistry
  • Boston, MA
  • NPI 1194090415
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083724090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021213411",
            "telephone_number": "617-445-9880",
            "fax_number": "617-445-5746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 COLUMBIA RD",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021213411",
            "telephone_number": "617-445-9880",
            "fax_number": "617-445-5746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALKEMUS",
        "first_name": "CHARLES",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS, JD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "MA11207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mai Home Healthcare and Companion LLC
• Jennifer Mai
• Victoria Rose Mail, LMHC
• Brittany Maiuri
• Hektor Malita
• Kevin Mallozzi, DPT
• Anastasia Maltseva, MD
• Emma Jean Maltz
• Gayle A. Maneikis, PT
• Tessa Manhard

• General Practice Dentistry in Dorchester, MA
• Providers in Dorchester, MA by specialty
• General Practice Dentistry in Massachusetts

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.