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General NPI Number Information
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NPI Number | 1144003708
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Entity Type | Individual
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Provider Name | NADINE OMA MALIK DMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 4200 FL-524 STE 104
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City | COCOA
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State | FL
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Zip | 32926
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Country | US
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Telephone | 321-631-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 3933 WATEROAK WAY
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City | TITUSVILLE
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State | FL
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Zip | 32796-1476
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Country | US
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Telephone | 859-351-7560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28414
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License Number State | FL
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