Provider Demographics
NPI:1912688383
Name:MALIK, MARIAM ALI (DDS)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:ALI
Last Name:MALIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 ASHLEY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6665
Mailing Address - Country:US
Mailing Address - Phone:832-774-4483
Mailing Address - Fax:
Practice Address - Street 1:15040 FAIRFIELD VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5952
Practice Address - Country:US
Practice Address - Phone:281-940-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX398331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice