Provider Demographics
NPI:1811372303
Name:MAREDIA, IRENA (DDS)
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:MAREDIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MINONITE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:832-757-1009
Mailing Address - Fax:
Practice Address - Street 1:235 MINONITE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:832-757-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-25
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist