MEDICARE: MARYAM SINA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	S6-21	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457625832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM SINA DDS

Provider Business Mailing Address
First Line	:	2551 N GREEN VALLEY PKWY
Second Line	:	BLDG A SUITE 400
City	:	HENDERSON
State	:	NV
Zip	:	89014-0272
Country	:	US
Telephone Number	:	702-458-6684
Fax Number	:	702-450-9498

Provider Business Practice Location Address
First Line	:	2551 N GREEN VALLEY PKWY
Second Line	:	BLDG A SUITE 400
City	:	HENDERSON
State	:	NV
Zip	:	89014-0272
Country	:	US
Telephone Number	:	702-458-6684
Fax Number	:	702-450-9498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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Directions to “ MARYAM SINA DDS” Practice Location

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