Provider Demographics
NPI:1669558698
Name:MALMQUIST, JEFFREY (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MALMQUIST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5509
Mailing Address - Country:US
Mailing Address - Phone:978-532-2700
Mailing Address - Fax:978-532-8102
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5509
Practice Address - Country:US
Practice Address - Phone:978-532-2700
Practice Address - Fax:978-532-8102
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643021223G0001X
MA211611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice