Provider Demographics
NPI:1811340599
Name:MALIK USMAN DDS, PC
Entity type:Organization
Organization Name:MALIK USMAN DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:
Authorized Official - Last Name:USMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:774-208-4431
Mailing Address - Street 1:8559 SUDLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:571-350-9292
Mailing Address - Fax:571-482-6979
Practice Address - Street 1:8559 SUDLEY ROAD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:571-350-9292
Practice Address - Fax:571-482-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty