Organization
MALLICK ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIKHIL S MALLICK DDS (OWNER)
(207) 573-1243
Entity
Organization
Contact information
Practice address
1 CUMBERLAND PL STE 202, BANGOR, ME 04401-5088
(207) 573-1243
Mailing address
1 CUMBERLAND PL STE 202, BANGOR, ME 04401-5088
(207) 573-1243
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124382346
NPI
—
01
—
DEN4260
STATE DENTAL LICENSE
ME
Enumeration date
07/03/2019
Last updated
07/03/2019
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