Provider Demographics
NPI:1760836324
Name:BURNEY, MIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:
Last Name:BURNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-6732
Mailing Address - Country:US
Mailing Address - Phone:504-609-9077
Mailing Address - Fax:
Practice Address - Street 1:1750 SAINT CHARLES AVE UNIT CU1
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-6732
Practice Address - Country:US
Practice Address - Phone:504-609-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00014011223G0001X
LA7040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7040OtherDENTAL LICENSE