Healthcare Provider Details

I. General information

NPI: 1871419713
Provider Name (Legal Business Name): MARYAM OTHMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 INDIANAPOLIS BLVD
HAMMOND IN
46324-3348
US

IV. Provider business mailing address

13240 BAYWOOD LN 13240 BAYWOOD LN
HOMER GLEN IL
60491-5990
US

V. Phone/Fax

Practice location:
  • Phone: 219-364-6388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015087A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: