Provider Demographics
NPI:1629309794
Name:MIRZA, JAVERIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAVERIA
Middle Name:
Last Name:MIRZA
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 1:1331 N ELM ST STE 102
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6303
Mailing Address - Country:US
Mailing Address - Phone:336-378-9630
Mailing Address - Fax:336-370-9608
Practice Address - Street 1:1331 N ELM ST STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6303
Practice Address - Country:US
Practice Address - Phone:336-378-9630
Practice Address - Fax:336-370-9608
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO24314001223G0001X
VA04014128651223G0001X
NC105201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice