Individual
ISRA MALIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
33 BLACK SPARROW DR, PORTLAND, ME 04102-1633
(240) 688-7596
Mailing address
33 BLACK SPARROW DR, PORTLAND, ME 04102-1633
(240) 688-7596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418934
VA
Other
Enumeration date
04/23/2024
Last updated
08/05/2024
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