Healthcare Provider Details

I. General information

NPI: 1194168187
Provider Name (Legal Business Name): DANIEL MIRCI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 E 2100 S
SALT LAKE CITY UT
84109-1152
US

IV. Provider business mailing address

3343 S 3040 E
SALT LAKE CITY UT
84109-3169
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-3836
  • Fax:
Mailing address:
  • Phone: 801-425-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8698624-9924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: