Provider Demographics
NPI:1922641083
Name:MARIAM BARIKBIN, DMD, PA
Entity Type:Organization
Organization Name:MARIAM BARIKBIN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARIKBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-389-3694
Mailing Address - Street 1:4114 HERSCHEL ST STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2200
Mailing Address - Country:US
Mailing Address - Phone:904-389-3694
Mailing Address - Fax:
Practice Address - Street 1:4114 HERSCHEL ST STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2200
Practice Address - Country:US
Practice Address - Phone:904-389-3694
Practice Address - Fax:904-389-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental