Provider Demographics
NPI:1417718701
Name:MAREDIA DENTAL GROUP
Entity Type:Organization
Organization Name:MAREDIA DENTAL GROUP
Other - Org Name:ETHOS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-747-1009
Mailing Address - Street 1:235 MINONITE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:823-757-1009
Mailing Address - Fax:
Practice Address - Street 1:235 MINONITE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-757-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty