Provider Demographics
NPI:1467652735
Name:SHOLEHVAR, MARYAM (DMD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:SHOLEHVAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7901
Mailing Address - Country:US
Mailing Address - Phone:610-437-4486
Mailing Address - Fax:610-437-5071
Practice Address - Street 1:1104 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7901
Practice Address - Country:US
Practice Address - Phone:610-437-4486
Practice Address - Fax:610-437-5071
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027959L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142980OtherBLUE SHIELD
PA417742OtherDELTA DENTAL