Taha Mirza, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019031740 Issued in IL

Practice address

845 S Perryville Rd
Rockford, IL 61108-4340

Phone

(779) 423-2135

NPI assigned

Jun 19, 2018

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1982198354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W SILVERLEAF CT",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601016403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084340",
            "telephone_number": "779-423-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRZA",
        "first_name": "TAHA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019031740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kami Minor
• William Stephen Minore, M.D.
• Kristine Joy Mique
• Laura M Miranda, LMT
• Razvan Cornel Mirza, D.D.S.
• Stefania Teresa Missanelli, OTR
• David R. Mitchell, MD
• Jennifer Mitchell, LMFT
• Patricia Anne Mitchell, PMHNP
• Patrick Mitsos

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.