Healthcare Provider Details

I. General information

NPI: 1225291800
Provider Name (Legal Business Name): MALIK MUHAMMAD USMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8559 SUDLEY RD
MANASSAS VA
20110-3811
US

IV. Provider business mailing address

5615 WEBSTERS WAY
MANASSAS VA
20112-3489
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-9292
  • Fax: 703-257-7103
Mailing address:
  • Phone: 240-505-2012
  • Fax: 703-257-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: