MEDICARE: MUBARIK ALI MALIK 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	DSO 20404-L	PA

General Provider Information

NPI Number	:	1356323703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUBARIK ALI MALIK DDS

Provider Business Mailing Address
First Line	:	2919 N 22ND ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19132
Country	:	US
Telephone Number	:	215-227-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 N 22ND ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19132
Country	:	US
Telephone Number	:	215-227-0107
Fax Number	:	215-228-2325

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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