Provider Demographics
NPI:1447285887
Name:ATEIA, MARYAM G (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:G
Last Name:ATEIA
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:10399 LEMON AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3770
Mailing Address - Country:US
Mailing Address - Phone:909-466-7966
Mailing Address - Fax:909-466-9519
Practice Address - Street 1:10399 LEMON AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3770
Practice Address - Country:US
Practice Address - Phone:909-466-7966
Practice Address - Fax:909-466-9519
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA48339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist