Provider Demographics
NPI:1346430568
Name:IDRISS, MAISA M (DMD)
Entity type:Individual
Prefix:DR
First Name:MAISA
Middle Name:M
Last Name:IDRISS
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 1:16215 NORTH FREEWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:281-444-0030
Mailing Address - Fax:281-440-5192
Practice Address - Street 1:16215 NORTH FREEWAY
Practice Address - Street 2:STE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-444-0030
Practice Address - Fax:281-440-5192
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist