Provider Demographics
NPI:1215598412
Name:MALIK, NEHAL (DDS)
Entity Type:Individual
Prefix:
First Name:NEHAL
Middle Name:
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 1:104 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3629
Mailing Address - Country:US
Mailing Address - Phone:847-323-9955
Mailing Address - Fax:
Practice Address - Street 1:104 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3629
Practice Address - Country:US
Practice Address - Phone:847-323-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600206122300000X, 1223G0001X
PADS043437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice