Organization
GRANITE STATE ORAL SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALMAN AYUB MALIK D.M.D., M.D. (OWNER)
(603) 432-3308
Entity
Organization
Contact information
Practice address
80 NASHUA RD, BUILDING C, LONDONDERRY, NH 03053-3426
(603) 432-3308
(603) 425-6165
Mailing address
80 NASHUA RD, BUILDING C, LONDONDERRY, NH 03053-3426
(603) 432-3308
(603) 425-6165
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3025
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0206381Y0NH01
ANTHEM ID
NH
01
—
1417977737
TYPE 1 NPI
NH
05
—
30312701
—
NH
Enumeration date
05/30/2007
Last updated
08/22/2020
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