Provider Demographics
NPI:1487421137
Name:NOTARIANNI, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:NOTARIANNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1215
Mailing Address - Country:US
Mailing Address - Phone:570-335-8250
Mailing Address - Fax:
Practice Address - Street 1:801 OLD YORK RD STE 403
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1625
Practice Address - Country:US
Practice Address - Phone:215-277-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist