Provider Demographics
NPI:1619503299
Name:MALIK, MOZAMEL AHMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOZAMEL
Middle Name:AHMED
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 1:220 PONCE DE LEON PL UNIT 343
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3256
Mailing Address - Country:US
Mailing Address - Phone:404-781-4467
Mailing Address - Fax:
Practice Address - Street 1:4112 ATLANTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4930
Practice Address - Country:US
Practice Address - Phone:470-385-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice