Provider Demographics
NPI:1386350841
Name:MALIK, NISREEN (BDS, DDS, MFD, MBA)
Entity type:Individual
Prefix:DR
First Name:NISREEN
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:BDS, DDS, MFD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 NE SUNSET BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4018
Mailing Address - Country:US
Mailing Address - Phone:425-226-2615
Mailing Address - Fax:425-226-5126
Practice Address - Street 1:4444 NE SUNSET BLVD STE 3
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4018
Practice Address - Country:US
Practice Address - Phone:425-226-2615
Practice Address - Fax:425-226-5126
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613747811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
123456789OtherSELF CREATED RANDOM NUMBERS