Provider Demographics
NPI:1962479311
Name:MOHAMMED MALEK, DDS MARY KNIGHT, DDS,PA
Entity Type:Organization
Organization Name:MOHAMMED MALEK, DDS MARY KNIGHT, DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-266-3380
Mailing Address - Street 1:1008 BIG OAK CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8841
Mailing Address - Country:US
Mailing Address - Phone:919-266-3380
Mailing Address - Fax:919-266-3319
Practice Address - Street 1:1008 BIG OAK CT
Practice Address - Street 2:SUITE C
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8841
Practice Address - Country:US
Practice Address - Phone:919-266-3380
Practice Address - Fax:919-266-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012H6Medicaid
NC012H6OtherBCBS