MEDICARE: DR. MIRA DIORA D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN014769	GA

General Provider Information

NPI Number	:	1184986036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRA DIORA D.D.S

Provider Business Mailing Address
First Line	:	943 PEACHTREE ST NE
Second Line	:	UNIT #1010
City	:	ATLANTA
State	:	GA
Zip	:	30309-3936
Country	:	US
Telephone Number	:	248-202-0131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1210
City	:	ATLANTA
State	:	GA
Zip	:	30361-3528
Country	:	US
Telephone Number	:	404-874-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	02/27/2015

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