Provider Demographics
NPI:1386776565
Name:ASTAR, MITRA MIA (DDS)
Entity type:Individual
Prefix:
First Name:MITRA
Middle Name:MIA
Last Name:ASTAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MITRA
Other - Middle Name:MIA
Other - Last Name:ASTAR RAZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:229 OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528
Mailing Address - Country:US
Mailing Address - Phone:914-921-9080
Mailing Address - Fax:
Practice Address - Street 1:26 PONDFIELD RD WEST
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-779-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04205811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics