Provider Demographics
NPI:1386484673
Name:ESSERGHINI, MARIAM (DMD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ESSERGHINI
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 1:22 RIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2614
Mailing Address - Country:US
Mailing Address - Phone:857-504-5462
Mailing Address - Fax:
Practice Address - Street 1:48 MARKET ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1005
Practice Address - Country:US
Practice Address - Phone:781-400-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100004341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice