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General NPI Number Information
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NPI Number | 1992088785
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Entity Type | Organization
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Legal Business Name | NICHOLAS COSMETIC DENTAL CENTER INC
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 1128 WALNUT STREET 5TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 646-241-6384
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 WALNUT STREET 5TH FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | SHIREEN MALIK
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Credential |
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Telephone | 917-239-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS038604
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License Number State | PA
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