Provider Demographics
NPI:1104050574
Name:MIGLIETTA-ROTHMAN, MARY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MIGLIETTA-ROTHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANDREW
Other - Last Name:MIGLIETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8920 WILSHIRE BLVD.
Mailing Address - Street 2:SU. 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2004
Mailing Address - Country:US
Mailing Address - Phone:310-652-2360
Mailing Address - Fax:310-652-2366
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SU. 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2004
Practice Address - Country:US
Practice Address - Phone:310-652-2360
Practice Address - Fax:310-652-2366
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist