Provider Demographics
NPI:1982125936
Name:MALEK & KNIGHT, DDS PA VII
Entity Type:Organization
Organization Name:MALEK & KNIGHT, DDS PA VII
Other - Org Name:AXIOM DENTISTRY OF LOUISBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-495-7043
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-0297
Mailing Address - Country:US
Mailing Address - Phone:919-495-3388
Mailing Address - Fax:
Practice Address - Street 1:110 SHANNON VLG
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2606
Practice Address - Country:US
Practice Address - Phone:919-496-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty