NPIMap

Organization Active NPI

Richard J Sorbera DDS Shilby D Malouf DDS Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Somerville, MA
National Provider Identifier
1164597217
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
9637 Issued in MA
Legal business name
RICHARD J SORBERA DDS SHILBY D MALOUF DDS INC
Practice address
366 Broadway
Somerville, MA 01245-2812
Phone
(617) 628-8000
Fax
(617) 628-2370
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Shilby D Malouf Jr., DDS
Title
Vice President
Phone
(617) 628-8000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 9637 MA Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 9458 MA

Addresses

Primary practice location

366 Broadway
Somerville, MA 01245-2812

Mailing address

366 Broadway
Somerville, MA 01245-2812
Phone (617) 628-8000

Other identifiers 4

IdentifierTypeStateIssuer
X03044OtherMARS
0202061MedicaidMA
0223573MedicaidMA
X03159OtherMARS

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164597217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 BROADWAY",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "012452812",
            "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",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "012452812",
            "telephone_number": "617-628-8000",
            "fax_number": "617-628-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD J SORBERA DDS SHILBY D MALOUF DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALOUF",
        "authorized_official_first_name": "SHILBY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "617-628-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "9637",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MA",
            "license": "9458",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RS",
            "identifier": "X03044",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0202061",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0223573",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RS",
            "identifier": "X03159",
            "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 Aug 22, 2020; 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.