Provider Demographics
NPI:1659629624
Name:HO, MIRAN (DDS)
Entity Type:Individual
Prefix:
First Name:MIRAN
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MIRAN
Other - Middle Name:H
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3440 E BASELINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7247
Mailing Address - Country:US
Mailing Address - Phone:480-926-2350
Mailing Address - Fax:
Practice Address - Street 1:3440 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7247
Practice Address - Country:US
Practice Address - Phone:480-926-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD008566OtherDENTAL LICENSE