Provider Demographics
NPI:1811492382
Name:MALEK & KNIGHT DDS PA-IIL
Entity type:Organization
Organization Name:MALEK & KNIGHT DDS PA-IIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-266-3380
Mailing Address - Street 1:1008 BIG OAK CT STE C
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6566
Mailing Address - Country:US
Mailing Address - Phone:919-266-3380
Mailing Address - Fax:919-679-3552
Practice Address - Street 1:9201 LEESVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613
Practice Address - Country:US
Practice Address - Phone:919-844-2250
Practice Address - Fax:919-844-2251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMED MALEK, DDS MARY KNIGHT, DDS,PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty