Provider Demographics
NPI:1902012669
Name:BEYDOUN, MIRIAM MAYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:MAYA
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SW 67TH AVE APT 1025
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7858
Mailing Address - Country:US
Mailing Address - Phone:305-665-5160
Mailing Address - Fax:305-665-5160
Practice Address - Street 1:432 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1021
Practice Address - Country:US
Practice Address - Phone:305-326-7159
Practice Address - Fax:305-324-5875
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14996122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice