Provider Demographics
NPI:1982726196
Name:SARMICANIC, MARIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:SARMICANIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:230
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-972-9949
Mailing Address - Fax:818-972-9948
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:230
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-972-9949
Practice Address - Fax:818-972-9948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice