Provider Demographics
NPI:1326179383
Name:MIRMAN, BRIAN F (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:MIRMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 HYLAN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:718-667-6000
Mailing Address - Fax:718-667-6350
Practice Address - Street 1:2627 HYLAN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:718-667-6000
Practice Address - Fax:718-667-6350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics