Provider Demographics
NPI:1790239242
Name:SULTAN, MARIUM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIUM
Middle Name:
Last Name:SULTAN
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 1:680 W SAM HOUSTON PKWY S APT 138
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1578
Mailing Address - Country:US
Mailing Address - Phone:646-400-4068
Mailing Address - Fax:
Practice Address - Street 1:680 W SAM HOUSTON PKWY S APT 138
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-1578
Practice Address - Country:US
Practice Address - Phone:646-400-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1026452001223G0001X
TX349161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice