Provider Demographics
NPI:1447576046
Name:MIRAMAR FAMILY DENTISTRY, INC
Entity Type:Organization
Organization Name:MIRAMAR FAMILY DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIADIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-437-6855
Mailing Address - Street 1:9720 STIRLING ROAD
Mailing Address - Street 2:211
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-437-6855
Mailing Address - Fax:954-431-5740
Practice Address - Street 1:9720 STIRLING ROAD
Practice Address - Street 2:211
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-437-6855
Practice Address - Fax:954-431-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN124371223G0001X
FLDN116491223G0001X
FLDN202491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty