1073997748 NPI number — DR. MARIAM NAEEM DMD

Table of content: DR. MARIAM NAEEM DMD (NPI 1073997748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073997748 NPI number — DR. MARIAM NAEEM DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAEEM
Provider First Name:
MARIAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073997748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2230 GALLOWS RD
Provider Second Line Business Mailing Address:
SUIT 320
Provider Business Mailing Address City Name:
DUNN LORING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22027-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-573-8664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SPECTRUM CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 1500
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-668-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS040539 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: VA 0401414993 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)