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General NPI Number Information
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NPI Number | 1447374160
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Entity Type | Individual
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Provider Name | MANJIT S MALLIK DDS
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9610 57TH AVE #2H
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City | CORONA
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State | NY
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Zip | 11368-3436
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Country | US
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Telephone | 718-271-3995
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Fax | 718-271-0021
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Provider Business Mailing Address
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Address Line | 10 OTSEGO AVE
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City | DIX HILLS
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State | NY
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Zip | 11746-8011
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Country | US
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Telephone | 631-242-4478
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Fax | 631-643-2274
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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 | 039145
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License Number State | NY
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