Provider Demographics
NPI:1215052410
Name:HORIYAT, MARYAM (DDS)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:HORIYAT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23998 SKYLINE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1872
Mailing Address - Country:US
Mailing Address - Phone:949-230-3939
Mailing Address - Fax:949-829-0000
Practice Address - Street 1:23998 SKYLINE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1872
Practice Address - Country:US
Practice Address - Phone:949-230-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice