Provider Demographics
NPI:1477343341
Name:ZARGAR, MARYAM BELLA
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:BELLA
Last Name:ZARGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 SPRINGVALE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7347
Mailing Address - Country:US
Mailing Address - Phone:202-802-1008
Mailing Address - Fax:
Practice Address - Street 1:1812 DUNLAWTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2925
Practice Address - Country:US
Practice Address - Phone:386-233-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305011223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program