Provider Demographics
NPI:1568293306
Name:MIRZA DENTAL
Entity type:Organization
Organization Name:MIRZA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:UMAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-962-6745
Mailing Address - Street 1:300A PRINCETON HIGHTSTOWN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-1421
Mailing Address - Country:US
Mailing Address - Phone:609-632-2155
Mailing Address - Fax:
Practice Address - Street 1:300A PRINCETON HIGHTSTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1421
Practice Address - Country:US
Practice Address - Phone:609-632-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental