Provider Demographics
NPI:1023368958
Name:MEMORIAL DENTISTS, PC
Entity Type:Organization
Organization Name:MEMORIAL DENTISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-558-8888
Mailing Address - Street 1:14565 MEMORIAL DR.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3023
Mailing Address - Country:US
Mailing Address - Phone:281-558-8888
Mailing Address - Fax:281-558-8368
Practice Address - Street 1:14565 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5430
Practice Address - Country:US
Practice Address - Phone:281-558-8888
Practice Address - Fax:281-558-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282321223G0001X
TX283711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty