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General NPI Number Information
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NPI Number | 1427716752
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Entity Type | Individual
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Provider Name | MARIYAM ANVARHUSEN INDAWALA BDS,MDS
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Gender | Female
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 1250 GARTH RD STE B
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City | BAYTOWN
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State | TX
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Zip | 77520-2424
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Country | US
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Telephone | 832-572-5820
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 SANTAVY ST APT 2107
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City | BAYTOWN
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State | TX
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Zip | 77521-2467
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Country | US
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Telephone | 646-262-9106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 38038
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License Number State | TX
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