Healthcare Provider Details

I. General information

NPI: 1932531639
Provider Name (Legal Business Name): MARYAM SINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 N GREEN VALLEY PKWY SUITE 400A
HENDERSON NV
89014-0272
US

IV. Provider business mailing address

2551 N GREEN VALLEY PKWY SUITE 400A
HENDERSON NV
89014-0272
US

V. Phone/Fax

Practice location:
  • Phone: 702-458-6684
  • Fax: 702-450-9498
Mailing address:
  • Phone: 702-458-6684
  • Fax: 702-450-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberS6-21
License Number StateNV

VIII. Authorized Official

Name: MARYAM SINA
Title or Position: OWNER
Credential: D.D.S.
Phone: 702-458-6684