Provider Demographics
NPI:1447305065
Name:SUSSMAN MIROCZNIK, IRIT (DDS)
Entity type:Individual
Prefix:DR
First Name:IRIT
Middle Name:
Last Name:SUSSMAN MIROCZNIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IRIT
Other - Middle Name:
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14 HEYWARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-7823
Mailing Address - Country:US
Mailing Address - Phone:718-260-4600
Mailing Address - Fax:718-852-0867
Practice Address - Street 1:14 HEYWARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-7823
Practice Address - Country:US
Practice Address - Phone:718-260-4600
Practice Address - Fax:718-852-0867
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist