Provider Demographics
NPI:1770879702
Name:MALIK, SAWAN KYLE (DMD)
Entity type:Individual
Prefix:DR
First Name:SAWAN
Middle Name:KYLE
Last Name:MALIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2116
Mailing Address - Country:US
Mailing Address - Phone:954-916-7664
Mailing Address - Fax:
Practice Address - Street 1:1027 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2116
Practice Address - Country:US
Practice Address - Phone:954-916-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics