Provider Demographics
NPI:1326313057
Name:MIRENAYAT, AMIRALI (DDS)
Entity Type:Individual
Prefix:
First Name:AMIRALI
Middle Name:
Last Name:MIRENAYAT
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 1:1133 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5839
Mailing Address - Country:US
Mailing Address - Phone:559-781-7242
Mailing Address - Fax:
Practice Address - Street 1:1133 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5839
Practice Address - Country:US
Practice Address - Phone:559-781-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist