Provider Demographics
NPI:1588815005
Name:KOHLI, MALIKA (DMD, MS,CAGS)
Entity Type:Individual
Prefix:DR
First Name:MALIKA
Middle Name:
Last Name:KOHLI
Suffix:
Gender:F
Credentials:DMD, MS,CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 COLUMBIA PIKE
Mailing Address - Street 2:#280
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4469
Mailing Address - Country:US
Mailing Address - Phone:571-312-4111
Mailing Address - Fax:571-312-4133
Practice Address - Street 1:2407 COLUMBIA PIKE
Practice Address - Street 2:#280
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4469
Practice Address - Country:US
Practice Address - Phone:571-312-4111
Practice Address - Fax:571-312-4133
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222041223P0300X
VA04014130561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice