Healthcare Provider Details

I. General information

NPI: 1134416746
Provider Name (Legal Business Name): MICHELLE UMARAH MIAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2011
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S ZANG ST
LITTLETON CO
80127-4608
US

IV. Provider business mailing address

1777 CHESTNUT PL APT 2101
DENVER CO
80202-6585
US

V. Phone/Fax

Practice location:
  • Phone: 720-330-2712
  • Fax:
Mailing address:
  • Phone: 919-308-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855771
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1855771
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number65339
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number00204260
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: