Provider Demographics
NPI:1376197848
Name:ABADIR, MARIAM SAMIR
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:SAMIR
Last Name:ABADIR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARIAM
Other - Middle Name:SAMIR
Other - Last Name:ABADIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:620 IRIS AVE APARTMENT #320
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 WESTWOOD DR. SUITE K
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-826-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1039761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice