Individual
DARRON IKARI MIYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
104627
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104627
CALIFORNIA DENTAL BOARD
CA
Enumeration date
08/18/2020
Last updated
09/10/2020
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