Provider Demographics
NPI:1194578864
Name:KALLEL SOUAYAH, MALEK (DMD, DDS)
Entity type:Individual
Prefix:
First Name:MALEK
Middle Name:
Last Name:KALLEL SOUAYAH
Suffix:
Gender:F
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:MALEK
Other - Middle Name:
Other - Last Name:KALLEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 CHURCH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-5070
Mailing Address - Country:US
Mailing Address - Phone:413-437-3543
Mailing Address - Fax:
Practice Address - Street 1:576 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7130
Practice Address - Country:US
Practice Address - Phone:781-995-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100000091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice