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General NPI Number Information
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NPI Number | 1992290456
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Entity Type | Individual
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Provider Name | MARIAM BAWANY DMD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 320 E ARMSTRONG AVE
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City | PEORIA
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State | IL
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Zip | 61603-3172
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Country | US
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Telephone | 309-624-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 PENNSBURY LN
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City | HANOVER PARK
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State | IL
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Zip | 60133-6712
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Country | US
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Telephone | 773-946-2384
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.031633
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License Number State | IL
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