MEDICARE: SARAH ANN MIR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DEN1002028	DC
2	1223P0221X	Pediatric Dentistry	16987	MD
3	1223P0221X	Pediatric Dentistry	13345	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1234	OTHER	NY	NO ISSUER
2	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1841738861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN MIR DDS

Provider Business Mailing Address
First Line	:	28 PEMBROKE HL
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 QUEEN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-1901
Country	:	US
Telephone Number	:	631-897-2504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	11/21/2023

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Directions to “ SARAH ANN MIR DDS” Practice Location

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