MEDICARE: DIMPLE MALIK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11732	MN

General Provider Information

NPI Number	:	1760690390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMPLE MALIK D.D.S.

Provider Business Mailing Address
First Line	:	715 FLORIDA AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55426-1719
Country	:	US
Telephone Number	:	612-432-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 FLORIDA AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55426-1719
Country	:	US
Telephone Number	:	612-432-0933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	12/18/2014

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