Provider Demographics
NPI:1467490565
Name:MIRAS, MYRIAM CARIDAD (DMD,)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:CARIDAD
Last Name:MIRAS
Suffix:
Gender:F
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:770-455-8725
Mailing Address - Fax:770-925-8795
Practice Address - Street 1:3312 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4353
Practice Address - Country:US
Practice Address - Phone:770-455-8725
Practice Address - Fax:770-925-8795
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00329227BMedicaid