Provider Demographics
NPI:1013270313
Name:MIRKAL, MINAXI (DDS)
Entity Type:Individual
Prefix:
First Name:MINAXI
Middle Name:
Last Name:MIRKAL
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 1:3821 LONG PRAIRIE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1599
Mailing Address - Country:US
Mailing Address - Phone:972-885-9191
Mailing Address - Fax:
Practice Address - Street 1:3821 LONG PRAIRIE RD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1599
Practice Address - Country:US
Practice Address - Phone:972-885-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30431122300000X, 1223G0001X
MADN1856021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist