Provider Demographics
NPI:1891495362
Name:TAWFIK, MARYAM IM (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:IM
Last Name:TAWFIK
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35732 GARNER ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-4128
Mailing Address - Country:US
Mailing Address - Phone:313-808-6060
Mailing Address - Fax:
Practice Address - Street 1:35732 GARNER ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-4128
Practice Address - Country:US
Practice Address - Phone:313-808-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29520007431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice