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NPI Code Detail

MEDICARE: MS. MARYAM A AL UBAIDI DMD

MEDICARE: MS. MARYAM A AL UBAIDI DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDDS106248CA

General Provider Information

NPI Number : 1770112765
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARYAM A AL UBAIDI DMD
Provider Business Mailing Address
First Line : 1555 RIVIERA AVE APT 619
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-7312
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6660 LONE TREE WAY STE 7
Second Line :
City : BRENTWOOD
State : CA
Zip : 94513-5310
Country : US
Telephone Number : 925-513-8363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2020
Last Update Date : 08/31/2021

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