Provider Demographics
NPI:1811021868
Name:MIAR, MARMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARMAR
Middle Name:
Last Name:MIAR
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 1:515 JUNCTION RD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2151
Mailing Address - Country:US
Mailing Address - Phone:608-829-0101
Mailing Address - Fax:608-829-0109
Practice Address - Street 1:515 JUNCTION RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2151
Practice Address - Country:US
Practice Address - Phone:608-829-0101
Practice Address - Fax:608-829-0109
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4879-0151223G0001X
CA536771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI392039101OtherFEDERAL TAX ID #