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NPI Code Detail

MEDICARE: NOEL S. MIRANDA, DMD INC.

MEDICARE: NOEL S. MIRANDA, DMD INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1174996516
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOEL S. MIRANDA, DMD INC.
Provider Business Mailing Address
First Line : 1486 HUNTINGTON AVE STE 302
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-5971
Country : US
Telephone Number : 650-583-8822
Fax Number :
Provider Business Practice Location Address
First Line : 1486 HUNTINGTON AVE STE 302
Second Line :
City : SOUTH SAN FRANCISCO
State : CA
Zip : 94080-5971
Country : US
Telephone Number : 650-583-8822
Fax Number :
Authorized Official
Title or Position : DMD
Name : DR. NOEL S MIRANDA
Credential : DMD
Telephone Number : 650-583-8822
Provider Enumeration Date : 11/06/2015
Last Update Date : 11/06/2015

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