Provider Demographics
NPI:1760444830
Name:MIRABELLI, ROBERT MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:MIRABELLI
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:4901 N 44TH ST
Mailing Address - Street 2:#101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2782
Mailing Address - Country:US
Mailing Address - Phone:602-595-3531
Mailing Address - Fax:602-595-3431
Practice Address - Street 1:4901 N 44TH ST
Practice Address - Street 2:#101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:602-595-3531
Practice Address - Fax:602-595-3431
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ59651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry