Provider Demographics
NPI:1508094848
Name:MALIK, GAURAV (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:MALIK
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 1:2 PILLSBURY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3523
Mailing Address - Country:US
Mailing Address - Phone:603-225-5371
Mailing Address - Fax:
Practice Address - Street 1:2 PILLSBURY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3523
Practice Address - Country:US
Practice Address - Phone:603-225-5371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04028122300000X
MADN1855344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist