Provider Demographics
NPI:1003820903
Name:NOSRATI, MIRIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:NOSRATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E 15TH ST
Mailing Address - Street 2:BUILDING 700A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6610
Mailing Address - Country:US
Mailing Address - Phone:405-285-8880
Mailing Address - Fax:405-285-8881
Practice Address - Street 1:1900 E 15TH ST
Practice Address - Street 2:BUILDING 700A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6610
Practice Address - Country:US
Practice Address - Phone:405-285-8880
Practice Address - Fax:405-285-8881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice