Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901020595 | MI |
NPI | 1003256140 |
---|---|
Provider Name | Dr. Omar Y Mirza |
First Address | Buffalo, NY 14263-3039 |
Second Address | Buffalo, NY 14263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 09/08/2018 |