Provider Demographics
NPI:1437994480
Name:TAWADROUS, MARIAM SAAD YOSEF (DMD)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:SAAD YOSEF
Last Name:TAWADROUS
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 1:2113 W GLADYS AVE UNIT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3174
Mailing Address - Country:US
Mailing Address - Phone:919-633-6550
Mailing Address - Fax:
Practice Address - Street 1:2340 N CALIFORNIA AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-6622
Practice Address - Country:US
Practice Address - Phone:773-365-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist