Provider Demographics
NPI:1689160533
Name:QURESHI, MARYAM RIAZ (DDS)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:RIAZ
Last Name:QURESHI
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 1:18111 PRESTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6600
Mailing Address - Country:US
Mailing Address - Phone:469-917-1220
Mailing Address - Fax:
Practice Address - Street 1:18111 PRESTON RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6600
Practice Address - Country:US
Practice Address - Phone:469-917-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37992122300000X
IL019031766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty