Provider Demographics
NPI:1306418611
Name:MEMON, HADIA (BDS)
Entity Type:Individual
Prefix:DR
First Name:HADIA
Middle Name:
Last Name:MEMON
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 MASSACHUSETTS AVENUE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:857-869-2747
Mailing Address - Fax:
Practice Address - Street 1:1786 MOON LAKE BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-882-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2023-10-03
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-10-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0345781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty