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General NPI Number Information
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NPI Number | 1255211371
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Entity Type | Organization
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Legal Business Name | MIRA SCANLON, DDS. PLLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 10 W 37TH ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10018-7481
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Country | US
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Telephone | 929-304-4937
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Fax |
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Provider Business Mailing Address
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Address Line | 3066 BRIGHTON 4TH ST APT 406
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City | BROOKLYN
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State | NY
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Zip | 11235-6588
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. MIRA GIULIETTA SCANLON
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Credential | DDS
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Telephone | 336-500-4786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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