Provider Demographics
NPI:1912188723
Name:PARSA, MITRA (DDS)
Entity Type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:PARSA
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 1:1449 SAN AMARO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7530
Mailing Address - Country:US
Mailing Address - Phone:904-993-4006
Mailing Address - Fax:
Practice Address - Street 1:5700 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3641
Practice Address - Country:US
Practice Address - Phone:410-589-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115021223X0400X
VA04014122491223X0400X
MD169571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics