Provider Demographics
NPI:1588710503
Name:MALO, BIPLAB KUMAR (DMD)
Entity type:Individual
Prefix:DR
First Name:BIPLAB
Middle Name:KUMAR
Last Name:MALO
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 1:80 FOSTER ST
Mailing Address - Street 2:UNIT-104
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5953
Mailing Address - Country:US
Mailing Address - Phone:978-944-4197
Mailing Address - Fax:
Practice Address - Street 1:80 FOSTER ST
Practice Address - Street 2:UNIT-104
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5953
Practice Address - Country:US
Practice Address - Phone:978-944-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist