Healthcare Provider Details

I. General information

NPI: 1194818815
Provider Name (Legal Business Name): NINA L MIRZAYAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GREEN VALLEY PKWY SUITE 8-E
HENDERSON NV
89074-5885
US

IV. Provider business mailing address

1701 N GREEN VALLEY PKWY SUITE 8-E
HENDERSON NV
89074-5885
US

V. Phone/Fax

Practice location:
  • Phone: 702-492-1955
  • Fax: 702-492-7663
Mailing address:
  • Phone: 702-492-1955
  • Fax: 702-492-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4365
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: