Provider Demographics
NPI:1588191738
Name:MEMON, RABIA QADIR (DMD)
Entity Type:Individual
Prefix:
First Name:RABIA
Middle Name:QADIR
Last Name:MEMON
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 1:2683 E MEAD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5106
Mailing Address - Country:US
Mailing Address - Phone:480-272-2101
Mailing Address - Fax:
Practice Address - Street 1:39355 CALIFORNIA ST STE 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1447
Practice Address - Country:US
Practice Address - Phone:510-794-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1049601223G0001X
MI29010224031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program