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Individual

RAHUL MALIK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
2702 WEST DEYOUNG STREET, MARION, IL 62959
(205) 639-7259
Mailing address
2702 W DEYOUNG ST, MARION, IL 62959-4950
(205) 639-7259

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029285
IL
1223G0001X
General Practice Dentistry
10776
CT
1223G0001X
General Practice Dentistry
DN1856010
MA

Other

Enumeration date
06/13/2012
Last updated
03/01/2013
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