Provider Demographics
NPI:1437993011
Name:WASEEM, MARYAM LINA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:LINA
Last Name:WASEEM
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 1:7600 MAJORCA PL APT 5041
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5561
Mailing Address - Country:US
Mailing Address - Phone:954-707-7762
Mailing Address - Fax:
Practice Address - Street 1:17365 US HIGHWAY 441 FL 32757
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6715
Practice Address - Country:US
Practice Address - Phone:352-270-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN291671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program