Active NPI
Mariyam Anvarhusen Indawala, BDS,MDS
- Prosthodontics
- Baytown, TX
National Provider Identifier
1427716752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 38038
- Practice address
- 1250 Garth Rd Ste B
Baytown, TX 77520-2424 - Phone
- (832) 572-5820
- NPI assigned
- Dec 3, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 38038 | TX | Primary |
Addresses
Primary practice location
1250 Garth Rd Ste B
Baytown, TX 77520-2424
Mailing address
1600 Santavy St Apt 2107
Baytown, TX 77521-2467
Phone (646) 262-9106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38038 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638489600000",
"number": "1427716752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 SANTAVY ST APT 2107",
"city": "BAYTOWN",
"state": "TX",
"postal_code": "775212467",
"telephone_number": "646-262-9106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 GARTH RD STE B",
"city": "BAYTOWN",
"state": "TX",
"postal_code": "775202424",
"telephone_number": "832-572-5820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INDAWALA",
"first_name": "MARIYAM",
"middle_name": "ANVARHUSEN",
"credential": "BDS,MDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-03",
"last_updated": "2021-12-03",
"certification_date": "2021-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TX",
"license": "38038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baytown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.