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General NPI Number Information
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NPI Number | 1386776565
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Entity Type | Individual
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Provider Name | MITRA MIA ASTAR DDS
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26 PONDFIELD RD WEST
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City | BRONXVILLE
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State | NY
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Zip | 10708
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Country | US
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Telephone | 914-779-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 229 OSBORN RD
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City | HARRISON
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State | NY
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Zip | 10528
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Country | US
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Telephone | 914-921-9080
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0420581
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License Number State | NY
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