Provider Demographics
NPI:1669039442
Name:MARYAM A CHIANI, DMD, LLC
Entity Type:Organization
Organization Name:MARYAM A CHIANI, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-341-0979
Mailing Address - Street 1:520 WASHINGTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2814
Mailing Address - Country:US
Mailing Address - Phone:412-341-0979
Mailing Address - Fax:412-341-0194
Practice Address - Street 1:520 WASHINGTON RD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2814
Practice Address - Country:US
Practice Address - Phone:412-341-0979
Practice Address - Fax:412-341-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA601439450-0006Medicaid