Provider Demographics
NPI:1124036108
Name:MALLIK, A. K. BOBBY (DMD)
Entity Type:Individual
Prefix:DR
First Name:A. K. BOBBY
Middle Name:
Last Name:MALLIK
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 1:3719 UNIVERSITY DR
Mailing Address - Street 2:STE B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6230
Mailing Address - Country:US
Mailing Address - Phone:919-493-5332
Mailing Address - Fax:919-493-8459
Practice Address - Street 1:3719 UNIVERSITY DR
Practice Address - Street 2:STE B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6230
Practice Address - Country:US
Practice Address - Phone:919-493-5332
Practice Address - Fax:919-493-8459
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist