Provider Demographics
NPI:1568136646
Name:KARRAR, MARIYAM (BDS, DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIYAM
Middle Name:
Last Name:KARRAR
Suffix:
Gender:F
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:HASANALI
Other - Last Name:BOHRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7501 80TH ST S STE 110
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3063
Mailing Address - Country:US
Mailing Address - Phone:651-459-7888
Mailing Address - Fax:
Practice Address - Street 1:7501 80TH ST S STE 110
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3063
Practice Address - Country:US
Practice Address - Phone:651-459-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14648122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist