Provider Demographics
NPI:1801088877
Name:KESHMIRI, MARYAM (DDS)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:KESHMIRI
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 1:11949 HESPERIA RD.
Mailing Address - Street 2:STE. A
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345
Mailing Address - Country:US
Mailing Address - Phone:760-244-1212
Mailing Address - Fax:760-244-2009
Practice Address - Street 1:11949 HESPERIA RD.
Practice Address - Street 2:STE. A
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-244-1212
Practice Address - Fax:760-244-2009
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist