Provider Demographics
NPI:1255211371
Name:MIRA SCANLON, DDS. PLLC
Entity type:Organization
Organization Name:MIRA SCANLON, DDS. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:GIULIETTA
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-500-4786
Mailing Address - Street 1:3066 BRIGHTON 4TH ST APT 406
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 W 37TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7481
Practice Address - Country:US
Practice Address - Phone:929-304-4937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty