Provider Demographics
NPI:1053792507
Name:JAVAID, MARIAM
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:JAVAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOLY FAMILY RD
Mailing Address - Street 2:APT #105
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2703
Mailing Address - Country:US
Mailing Address - Phone:267-338-5972
Mailing Address - Fax:
Practice Address - Street 1:48 HOLY FAMILY RD
Practice Address - Street 2:APT #105
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2703
Practice Address - Country:US
Practice Address - Phone:267-338-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18575401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry