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NPI Code Detail

MEDICARE: DR. MYRIAM MAHAFFEY D.D.S

MEDICARE:  DR. MYRIAM  MAHAFFEY  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
11223G0001XGeneral Practice Dentistry56807CA

General Provider Information

NPI Number : 1851562672
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MYRIAM MAHAFFEY D.D.S
Provider Business Mailing Address
First Line : PO BOX 193
Second Line :
City : LA QUINTA
State : CA
Zip : 92247-0193
Country : US
Telephone Number : 760-234-6497
Fax Number :
Provider Business Practice Location Address
First Line : 50855 WASHINGTON ST
Second Line : SUITE 2G
City : LA QUINTA
State : CA
Zip : 92253-2891
Country : US
Telephone Number : 760-234-6497
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2008
Last Update Date : 05/28/2009

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Directions to “ DR. MYRIAM MAHAFFEY D.D.S” Practice Location

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