Provider Demographics
NPI:1174917363
Name:MALIK, KIRAN SUMERNA (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:SUMERNA
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 1:1617 KINGS HWY N
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2303
Mailing Address - Country:US
Mailing Address - Phone:347-834-1880
Mailing Address - Fax:203-324-3935
Practice Address - Street 1:1617 KINGS HWY N
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2303
Practice Address - Country:US
Practice Address - Phone:347-834-1880
Practice Address - Fax:203-324-3935
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109861223G0001X
NJ22DI026227001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice