Provider Demographics
NPI:1043736051
Name:TING, MIRIAM (DMD, BDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:TING
Suffix:
Gender:F
Credentials:DMD, BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1751
Mailing Address - Country:US
Mailing Address - Phone:610-550-3333
Mailing Address - Fax:
Practice Address - Street 1:250 W LANCASTER AVE STE 215
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1751
Practice Address - Country:US
Practice Address - Phone:610-550-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413131223P0300X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty