Provider Demographics
NPI:1871033928
Name:MAREDIA, ANISA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANISA
Middle Name:A
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 1:10505 WEST GRAND PARKWAY SOUTH
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4328
Mailing Address - Country:US
Mailing Address - Phone:832-612-2829
Mailing Address - Fax:832-612-2830
Practice Address - Street 1:10505 WEST GRAND PARKWAY SOUTH
Practice Address - Street 2:SUITE 150
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4328
Practice Address - Country:US
Practice Address - Phone:832-612-2829
Practice Address - Fax:832-612-2830
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty