Mirawati Nusaputra
- Full Name:
- Mirawati Nusaputra
- Aliases:
-
- Mirawati Ali
- Registration Number:
- 77837
- Current Status:
- Member
- Designated Electoral District:
- District 7
This member is currently entitled to practise.
Practice Information
Primary Practice
St. Jacobs Dental Group
- Sedation & Anesthesia Facility Permit:
- Yes
- CT Scanner Facility Permit:
- No
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All Practice Locations
-
St. Jacobs Dental Group
- Sedation & Anesthesia Facility Permit:
- Yes
- CT Scanner Facility Permit:
- No
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Professional Corporation Information
-
Nusaputra Dentistry Professional Corporation
10 Parkside Dr Unit 5
St. Jacobs, ON, CA
N0B 2N0
Phone: 519-664-2434
- Certificate of Authorization Status:
- Current
- Certificate of Authorization Issuance:
- April 03, 2017
Academic Information
Dental Degree
- 2008
- University of Toronto, Canada
This may not be a complete record of the member's academic information or continuing education.
Certificate(s) of Registration
Current Certificate(s) of Registration and Date(s) of Issuance
- General
Initial Date of Registration
Sedation & Anesthesia Details
See All Associated Sedation & Anesthesia Facilities
-
- Address:
- 10 Parkside Dr PO Box 240 St. Jacobs, ON, CA N0B 2N0
- Phone #:
- (519) 664-2434
- Permit Status:
- Current
- Permit Type:
- Type B
- Facility Modality:
- Deep Sedation/General Anesthesia