Provider Demographics
NPI:1659627123
Name:BEMANI, MARYAM
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:BEMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 WHITE MARBLE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1658
Mailing Address - Country:US
Mailing Address - Phone:410-531-5050
Mailing Address - Fax:
Practice Address - Street 1:7305 BALTIMORE AVE STE 204
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3232
Practice Address - Country:US
Practice Address - Phone:301-927-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15152122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice