Provider Demographics
NPI:1144912502
Name:HACHEM, MALAK KAMAL (DDS)
Entity type:Individual
Prefix:DR
First Name:MALAK
Middle Name:KAMAL
Last Name:HACHEM
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 1:14549 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5130
Mailing Address - Country:US
Mailing Address - Phone:313-231-8281
Mailing Address - Fax:
Practice Address - Street 1:22701 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2574
Practice Address - Country:US
Practice Address - Phone:313-274-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist