Provider Demographics
NPI:1811906563
Name:MALIK, TARIQ PASHA (DDS)
Entity type:Individual
Prefix:MR
First Name:TARIQ
Middle Name:PASHA
Last Name:MALIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:518-465-0808
Mailing Address - Fax:518-465-1450
Practice Address - Street 1:540 BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:518-465-0808
Practice Address - Fax:518-465-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist