Provider Demographics
NPI:1043903909
Name:MEMON, ARIBA (DMD)
Entity type:Individual
Prefix:
First Name:ARIBA
Middle Name:
Last Name:MEMON
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 1:2652 RIDGE RUN TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4021
Mailing Address - Country:US
Mailing Address - Phone:678-722-1310
Mailing Address - Fax:
Practice Address - Street 1:2652 RIDGE RUN TRL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4021
Practice Address - Country:US
Practice Address - Phone:678-722-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist