Mira Giulietta Scanlon, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

108405 Issued in CA

Practice address

3429 Edgehill Dr Apt 3
Los Angeles, CA 90018-3640

Phone

(336) 500-4786

NPI assigned

Dec 8, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mira Giulietta Gottardi Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mira Scanlon, DDS. PLLC

  • Dentist
  • New York, NY
  • NPI 1255211371
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1689385775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3429 EDGEHILL DR APT 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900183640",
            "telephone_number": "336-500-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3429 EDGEHILL DR APT 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900183640",
            "telephone_number": "336-500-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "MIRA",
        "middle_name": "GIULIETTA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "108495",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "108405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRA",
            "last_name": "GOTTARDI",
            "middle_name": "GIULIETTA",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Norma Lucero Scalise
• Erin Scamurra
• Jane A Scanlan, CRNA
• Mia Scanlon, LCSW
• Michaela Scanlon
• Robin B. Scanlon, MD
• Christopher Scannell
• Zoe Scannell, N.P.
• Scanning Trend, Inc
• Stephanie Scapini

• Dentist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.