Healthcare Provider Details

I. General information

NPI: 1295184984
Provider Name (Legal Business Name): MALIK MUHAMMAD 68EX2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N PIEDRAS ST US ARMY DENTAL ACTIVITY
EL PASO TX
79920-5002
US

IV. Provider business mailing address

5005 N PIEDRAS ST US ARMY DENTAL ACTIVITY
EL PASO TX
79920-5002
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-9298
  • Fax:
Mailing address:
  • Phone: 915-742-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: