Provider Demographics
NPI:1164802336
Name:MALEK & KNIGHT, DDS, PA V
Entity Type:Organization
Organization Name:MALEK & KNIGHT, DDS, PA V
Other - Org Name:AXIOM DENTISTRY OF CLAYTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-266-3380
Mailing Address - Street 1:319 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2465
Mailing Address - Country:US
Mailing Address - Phone:919-553-3173
Mailing Address - Fax:
Practice Address - Street 1:319 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2465
Practice Address - Country:US
Practice Address - Phone:919-553-3173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7105OtherLICENSE