Provider Demographics
NPI:1447337167
Name:MIAN, ALIA A (DMD)
Entity type:Individual
Prefix:DR
First Name:ALIA
Middle Name:A
Last Name:MIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 PINECROFT DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2247
Mailing Address - Country:US
Mailing Address - Phone:502-797-2074
Mailing Address - Fax:
Practice Address - Street 1:2372 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2247
Practice Address - Country:US
Practice Address - Phone:502-797-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022431122300000X
GADN0142331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist