Provider Demographics
NPI:1306286265
Name:KARIMEDDINY-KALISH, MARIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:KARIMEDDINY-KALISH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DOWNER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1115
Mailing Address - Country:US
Mailing Address - Phone:781-749-1099
Mailing Address - Fax:
Practice Address - Street 1:20 DOWNER AVE STE 2
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1115
Practice Address - Country:US
Practice Address - Phone:781-749-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist