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General NPI Number Information
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NPI Number | 1437534898
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Entity Type | Individual
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Provider Name | ANDI MIRO DDS
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Gender | Female
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 30 E 76TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-2700
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Country | US
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Telephone | 212-794-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 15 TONE LN
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1649
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Country | US
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Telephone | 718-809-0431
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0580201
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License Number State | NY
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