Provider Demographics
NPI:1457625832
Name:SINA, MARYAM (DDS)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 N GREEN VALLEY PKWY
Mailing Address - Street 2:BLDG A SUITE 400
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0272
Mailing Address - Country:US
Mailing Address - Phone:702-458-6684
Mailing Address - Fax:702-450-9498
Practice Address - Street 1:2551 N GREEN VALLEY PKWY
Practice Address - Street 2:BLDG A SUITE 400
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0272
Practice Address - Country:US
Practice Address - Phone:702-458-6684
Practice Address - Fax:702-450-9498
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104879717Medicaid