Provider Demographics
NPI:1164885810
Name:MIR, FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:
Last Name:MIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MEHRDAD
Other - Middle Name:
Other - Last Name:MIRABRISHAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:375 WILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2300
Mailing Address - Country:US
Mailing Address - Phone:860-962-6495
Mailing Address - Fax:
Practice Address - Street 1:375 WILLARD AVE STE 5
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2384
Practice Address - Country:US
Practice Address - Phone:860-962-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13328204E00000X
390200000X
VA04014160391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program