Active NPI
Mandalene Jayne Mirkhah, DDS
- Dentist
- Phoenix, AZ
National Provider Identifier
1205197126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D008869
- Practice address
- 717 W Glendale Ave
Phoenix, AZ 85021-8629 - Phone
- (602) 561-4092
- NPI assigned
- Jun 7, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D008869 | AZ | Primary |
Addresses
Primary practice location
717 W Glendale Ave
Phoenix, AZ 85021-8629
Mailing address
717 W Glendale Ave
Phoenix, AZ 85021-8629
Phone (602) 861-0800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D008869 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mandalene Mirkhah DDS PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Phoenix, AZ
- NPI 1841708559
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510012800000",
"number": "1205197126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 W GLENDALE AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850218629",
"telephone_number": "602-861-0800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "717 W GLENDALE AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850218629",
"telephone_number": "602-561-4092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRKHAH",
"first_name": "MANDALENE",
"middle_name": "JAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-07",
"last_updated": "2017-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D008869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.