Active NPI
Mira Edgerton, DDS
- Prosthodontics
- Amherst, NY
National Provider Identifier
1851605117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 34337
- Practice address
- 3951 Main St
Amherst, NY 14226-3401 - Phone
- (716) 836-7250
- NPI assigned
- Jul 28, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 34337 | NY | Primary |
Addresses
Primary practice location
3951 Main St
Amherst, NY 14226-3401
Mailing address
3951 Main St
Amherst, NY 14226-3401
Phone (716) 836-7250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150818004151 | NY | Order and Referring Only - Oral Surgery | 6406161629 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34337 | NY | MD | Prosthodontist |
| 034337 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1851605117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3951 MAIN ST",
"city": "AMHERST",
"state": "NY",
"postal_code": "142263401",
"telephone_number": "716-836-7250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3951 MAIN ST",
"city": "AMHERST",
"state": "NY",
"postal_code": "142263401",
"telephone_number": "716-836-7250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGERTON",
"first_name": "MIRA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-28",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "NY",
"license": "34337",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amherst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.