Provider Demographics
NPI:1033273941
Name:MALIK, STEPHEN ROY (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROY
Last Name:MALIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 COMMERCE PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-6067
Mailing Address - Country:US
Mailing Address - Phone:614-882-6741
Mailing Address - Fax:614-882-6718
Practice Address - Street 1:180 COMMERCE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6067
Practice Address - Country:US
Practice Address - Phone:614-882-6741
Practice Address - Fax:614-882-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice