Provider Demographics
NPI:1306418611
Name:MEMON, HADIA (BDS)
Entity type:Individual
Prefix:DR
First Name:HADIA
Middle Name:
Last Name:MEMON
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 LOCUST ST UNIT 21
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4054
Mailing Address - Country:US
Mailing Address - Phone:604-715-5128
Mailing Address - Fax:
Practice Address - Street 1:4 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1931
Practice Address - Country:US
Practice Address - Phone:603-434-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2025-01-30
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-10-03
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH051371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty