Healthcare Provider Details

I. General information

NPI: 1134439144
Provider Name (Legal Business Name): MIRA KHAROTI DELLA CROCE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRA KHAROTI DMD, FAGD

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WILMONT MEWS
WEST CHESTER PA
19382-3206
US

IV. Provider business mailing address

14 WILMONT MEWS
WEST CHESTER PA
19382-3206
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-3446
  • Fax:
Mailing address:
  • Phone: 610-696-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10523
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS038260
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: