Provider Demographics
NPI:1942476171
Name:MIRANI, MARJAN (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MARJAN
Middle Name:
Last Name:MIRANI
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 1:462 N LINDEN DR
Mailing Address - Street 2:#336
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2247
Mailing Address - Country:US
Mailing Address - Phone:310-858-5933
Mailing Address - Fax:310-858-5924
Practice Address - Street 1:462 N LINDEN DR
Practice Address - Street 2:#336
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2247
Practice Address - Country:US
Practice Address - Phone:310-858-5933
Practice Address - Fax:310-858-5924
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice