Provider Demographics
NPI:1124115993
Name:MALIK, SCOTT A (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:MALIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 GLENVIEW ROAD
Mailing Address - Street 2:#102
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-724-1771
Mailing Address - Fax:847-724-1779
Practice Address - Street 1:1775 GLENVIEW ROAD
Practice Address - Street 2:#102
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-724-1771
Practice Address - Fax:847-724-1779
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice