Provider Demographics
NPI:1629745104
Name:MALIK, MAHNOOR AFTAB (DDS)
Entity Type:Individual
Prefix:
First Name:MAHNOOR
Middle Name:AFTAB
Last Name:MALIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2482
Mailing Address - Country:US
Mailing Address - Phone:517-482-8466
Mailing Address - Fax:
Practice Address - Street 1:1850 W MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2482
Practice Address - Country:US
Practice Address - Phone:517-482-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist