Individual
DYLAN MIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1300 SHIRLEY DR, METAIRIE, LA 70001-3339
(504) 237-2933
Mailing address
1017 MANSON AVE, METAIRIE, LA 70001-3613
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2638360
—
LA
Enumeration date
03/15/2023
Last updated
01/02/2024
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