Provider Demographics
NPI:1104879717
Name:MARYAM SINA DDS LTD
Entity type:Organization
Organization Name:MARYAM SINA DDS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-458-6684
Mailing Address - Street 1:2551 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE #400A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0272
Mailing Address - Country:US
Mailing Address - Phone:702-458-6684
Mailing Address - Fax:702-450-9498
Practice Address - Street 1:2551 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE #400A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0272
Practice Address - Country:US
Practice Address - Phone:702-458-6684
Practice Address - Fax:702-450-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002202360Medicaid