Provider Demographics
NPI:1508086026
Name:TABRIZI, MARYAM (DMD-MPH)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:F
Credentials:DMD-MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073
Mailing Address - Country:US
Mailing Address - Phone:610-353-0753
Mailing Address - Fax:610-353-5396
Practice Address - Street 1:1001 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4124
Practice Address - Country:US
Practice Address - Phone:702-774-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV77261223G0001X
TX308981223G0001X
PADS027760L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice