Provider Demographics
NPI:1205358389
Name:MALIK, SOBIA (DMD)
Entity Type:Individual
Prefix:
First Name:SOBIA
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N BROAD ST APT 500
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3434
Mailing Address - Country:US
Mailing Address - Phone:215-820-5641
Mailing Address - Fax:
Practice Address - Street 1:2400 MID LN STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4466
Practice Address - Country:US
Practice Address - Phone:713-714-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041301122300000X, 1223G0001X
TX337541223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice