Provider Demographics
NPI:1942826524
Name:MIRA DENTAL AT TYSONS CORNER PLLC
Entity Type:Organization
Organization Name:MIRA DENTAL AT TYSONS CORNER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CLAIM SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-533-4386
Mailing Address - Street 1:8201 GREENSBORO DR STE 710
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8201 GREENSBORO DR STE 710
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3818
Practice Address - Country:US
Practice Address - Phone:571-633-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty