Individual
MITRA TAHIREE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
29264 ARIEL ST, MURRIETA, CA 92563-2737
(951) 834-5888
Mailing address
29264 ARIEL ST, MURRIETA, CA 92563-2737
(951) 834-5888
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA56326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA56326
—
CA
Enumeration date
01/02/2017
Last updated
01/02/2017
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