Provider Demographics
NPI:1386017002
Name:AFIFI, MARYAM M (DMD, MS)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:M
Last Name:AFIFI
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1509
Mailing Address - Country:US
Mailing Address - Phone:909-476-8184
Mailing Address - Fax:
Practice Address - Street 1:12850 10TH ST STE B1
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4297
Practice Address - Country:US
Practice Address - Phone:909-613-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist