MEDICARE: DR. MALIKA ANNE MEBAREK LONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7158	NE

General Provider Information

NPI Number	:	1285049502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALIKA ANNE MEBAREK LONG DDS

Provider Business Mailing Address
First Line	:	1719 N COTNER BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1356
Country	:	US
Telephone Number	:	402-464-1719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 N COTNER BLVD
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-1356
Country	:	US
Telephone Number	:	402-646-1719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	07/21/2022

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