Edward Mirzoian, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

12798 Issued in CT

Practice address

179 Deming St Ste a
Manchester, CT 06042-7131

Phone

(860) 644-6500

NPI assigned

May 11, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Patrick Dermesropian PC

  • General Practice Dentistry
  • Manchester, CT
  • NPI 1184925257
  NPD (past)

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1851827828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 MAPLE AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061142733",
            "telephone_number": "860-977-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 DEMING ST STE A",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060427131",
            "telephone_number": "860-644-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZOIAN",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-11",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "12798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Minich, RPH
• Deborah Mininberg
• Stacey A Miranti
• Robert M Mirer, DDS
• Varvara S Mironova, M.D.
• Amanda Mitchell
• Latonya E Mitchell
• Levar Mitchell, LMSW
• Jyoti Mittal, PA
• Shanay Mitto

• Dentist in Manchester, CT
• Providers in Manchester, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; 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.

Verify at the official NPI Registry.