Provider Demographics
NPI:1851562672
Name:MAHAFFEY, MYRIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:
Last Name:MAHAFFEY
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:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92247-0193
Mailing Address - Country:US
Mailing Address - Phone:760-234-6497
Mailing Address - Fax:
Practice Address - Street 1:50855 WASHINGTON ST
Practice Address - Street 2:SUITE 2G
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2891
Practice Address - Country:US
Practice Address - Phone:760-234-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice