Provider Demographics
NPI:1275524134
Name:MALICK, ALEXANDER HOMER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:HOMER
Last Name:MALICK
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 1:1899 E ROSEVILLE PKWY
Mailing Address - Street 2:SUITE160
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7979
Mailing Address - Country:US
Mailing Address - Phone:916-787-1199
Mailing Address - Fax:916-787-0400
Practice Address - Street 1:1899 E ROSEVILLE PKWY
Practice Address - Street 2:SUITE160
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7979
Practice Address - Country:US
Practice Address - Phone:916-787-1199
Practice Address - Fax:916-787-0400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice