Provider Demographics
NPI:1245613538
Name:MIRI, SEYED AFSHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEYED
Middle Name:AFSHAN
Last Name:MIRI
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 1:5909 WAYMAKER CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1855
Mailing Address - Country:US
Mailing Address - Phone:512-431-6860
Mailing Address - Fax:
Practice Address - Street 1:651 BARNES DR
Practice Address - Street 2:205
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6198
Practice Address - Country:US
Practice Address - Phone:512-805-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist