Healthcare Provider Details

I. General information

NPI: 1306418611
Provider Name (Legal Business Name): HADIA MEMON BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date: 03/31/2023
Reactivation Date: 10/03/2023

III. Provider practice location address

4 MANCHESTER AVE
DERRY NH
03038-1931
US

IV. Provider business mailing address

285 LOCUST ST UNIT 21
WOBURN MA
01801-4054
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-1586
  • Fax:
Mailing address:
  • Phone: 604-715-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number05137
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: