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General NPI Number Information
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NPI Number | 1083068910
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Entity Type | Individual
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Provider Name | MIRA EGBARIA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 201 E HURON ST GALTER 2-246
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City | CHICAGO
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State | IL
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Zip | 60611-3197
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Country | US
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Telephone | 256-503-5241
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Fax |
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Provider Business Mailing Address
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Address Line | 2736 MUIR WOODS DR SE
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-8615
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Country | US
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Telephone | 256-503-5241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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