Provider Demographics
NPI:1821670365
Name:MEHBOOB, SHERRYHAN MALIK
Entity Type:Individual
Prefix:
First Name:SHERRYHAN
Middle Name:MALIK
Last Name:MEHBOOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1893
Mailing Address - Country:US
Mailing Address - Phone:617-659-0367
Mailing Address - Fax:
Practice Address - Street 1:129 N WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1893
Practice Address - Country:US
Practice Address - Phone:609-567-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029301001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice