Provider Demographics
NPI:1831492404
Name:MIYAHARA, CAROLE
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:
Last Name:MIYAHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 COLBY ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2091
Mailing Address - Country:US
Mailing Address - Phone:510-848-6494
Mailing Address - Fax:
Practice Address - Street 1:3010 COLBY STREET
Practice Address - Street 2:SUITE 217
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2059
Practice Address - Country:US
Practice Address - Phone:510-848-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADT390471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry