Provider Demographics
NPI:1588919948
Name:MALIK, FAREEHA (DMD)
Entity type:Individual
Prefix:DR
First Name:FAREEHA
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 S 99TH AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1404
Mailing Address - Country:US
Mailing Address - Phone:623-478-1624
Mailing Address - Fax:
Practice Address - Street 1:2755 S 99TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1404
Practice Address - Country:US
Practice Address - Phone:623-478-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008944122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist