NPIMap

Organization Active NPI

Joseph Mallouh D.D.S., P.C.

Doing business as Lakeside Dental Associates

  • Dentist
  • Shrewsbury, MA
National Provider Identifier
1841395076
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19877 Issued in MA
Legal business name
JOSEPH MALLOUH D.D.S., P.C.
Doing business as
Lakeside Dental Associates
Practice address
50 Boston Tpke
White City Shopping Center
Shrewsbury, MA 01545-3540
Phone
(508) 792-2991
Fax
(508) 799-7681
NPI assigned
Sep 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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. Joseph I Mallouh, D.D.S.
Title
Owner
Phone
(508) 792-2991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 19877 MA Primary

Addresses

Primary practice location

50 Boston Tpke
White City Shopping Center
Shrewsbury, MA 01545-3540

Mailing address

50 Boston Tpke
White City Shopping Center
Shrewsbury, MA 01545-3540
Phone (508) 792-2991

Other identifiers 1

IdentifierTypeStateIssuer
X12069OtherMABCBS ID #

Other names 1

  • LAKESIDE DENTAL ASSOCIATES Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Appleseed Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841395076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 BOSTON TPKE",
            "address_2": "WHITE CITY SHOPPING CENTER",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015453540",
            "telephone_number": "508-792-2991",
            "fax_number": "508-799-7681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BOSTON TPKE",
            "address_2": "WHITE CITY SHOPPING CENTER",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015453540",
            "telephone_number": "508-792-2991",
            "fax_number": "508-799-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH MALLOUH D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALLOUH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-792-2991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "19877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID #",
            "identifier": "X12069",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKESIDE DENTAL ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shrewsbury, 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.