Provider Demographics
NPI:1285049502
Name:LONG, MALIKA ANNE MEBAREK (DDS)
Entity type:Individual
Prefix:DR
First Name:MALIKA
Middle Name:ANNE MEBAREK
Last Name:LONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MALIKA
Other - Middle Name:
Other - Last Name:MEBAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1719 N COTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1356
Mailing Address - Country:US
Mailing Address - Phone:402-464-1719
Mailing Address - Fax:
Practice Address - Street 1:1719 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1356
Practice Address - Country:US
Practice Address - Phone:402-646-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist