Provider Demographics
NPI:1033896238
Name:NAEEM, MARYAM IMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:IMAD
Last Name:NAEEM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:IMAD
Other - Last Name:GHANIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14744 CROFTON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-4463
Mailing Address - Country:US
Mailing Address - Phone:248-657-0352
Mailing Address - Fax:
Practice Address - Street 1:14744 CROFTON DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-4463
Practice Address - Country:US
Practice Address - Phone:248-657-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist