Provider Demographics
NPI:1164620241
Name:DRS.MALIK&MALIK
Entity Type:Organization
Organization Name:DRS.MALIK&MALIK
Other - Org Name:DRS.MALIK&MALIK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR. MARTHA MANLEY MALIK
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:MANLEY
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-578-0381
Mailing Address - Street 1:805 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2145
Mailing Address - Country:US
Mailing Address - Phone:361-578-0381
Mailing Address - Fax:361-578-7794
Practice Address - Street 1:805 E MOCKINGBIRD LN
Practice Address - Street 2:SUITE D
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2145
Practice Address - Country:US
Practice Address - Phone:361-578-0381
Practice Address - Fax:361-578-7794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty