Provider Demographics
NPI:1235268434
Name:MIRABELLI, MAURIZIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:
Last Name:MIRABELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3105
Mailing Address - Country:US
Mailing Address - Phone:810-985-3200
Mailing Address - Fax:810-985-3752
Practice Address - Street 1:1903 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3105
Practice Address - Country:US
Practice Address - Phone:810-985-3200
Practice Address - Fax:810-985-3752
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G41022OtherBCBS MEDICAL
MI190009435OtherRAILROAD MEDICARE
MI0N98840Medicare ID - Type Unspecified