Healthcare Provider Details

I. General information

NPI: 1255547337
Provider Name (Legal Business Name): SUNANDA MALIK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PEMBERTON BROWNS MILL RD
BROWNS MILLS NJ
08015-3111
US

IV. Provider business mailing address

1604 STOKES RD
MOUNT LAUREL NJ
08054-6427
US

V. Phone/Fax

Practice location:
  • Phone: 609-893-5200
  • Fax: 609-893-7271
Mailing address:
  • Phone: 732-267-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02258400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: