Provider Demographics
NPI:1184986036
Name:DIORA, MIRA (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:DIORA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 PEACHTREE ST NE
Mailing Address - Street 2:UNIT #1010
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3936
Mailing Address - Country:US
Mailing Address - Phone:248-202-0131
Mailing Address - Fax:
Practice Address - Street 1:1175 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-3528
Practice Address - Country:US
Practice Address - Phone:404-874-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist