Individual provider Active NPI

Charles W Malta, DDS

  • Dentist
  • Stoneham, MA
National Provider Identifier
1477657781
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
16850 Issued in MA
Practice address
158 Main St
Stoneham, MA 02180-1619
Phone
(781) 438-5200
NPI assigned
Sep 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
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
Dentist 122300000X 16850 MA Primary

Addresses

Primary practice location

158 Main St
Stoneham, MA 02180-1619

Mailing address

158 Main Street
Stoneham, MA 02180
Phone (781) 438-5200

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150618001943 MA Order and Referring Only - DentistPractitioner - Dentist 9335450220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16850MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Charles W. Malta, D.D.S., P.C. Dentist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477657781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MAIN STREET",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "02180",
            "telephone_number": "781-438-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MAIN ST",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021801619",
            "telephone_number": "781-438-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALTA",
        "first_name": "CHARLES",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "16850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

Verify at the official NPI Registry.