MEDICARE: DR. JOSE MANUEL MIRANDA DMD

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
1	1223G0001X	General Practice Dentistry	1150	PR

General Provider Information

NPI Number	:	1700090669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MANUEL MIRANDA DMD

Provider Business Mailing Address
First Line	:	2TR510 VIA ADELINA
Second Line	:	VILLA FONTANA
City	:	CAROLINA
State	:	PR
Zip	:	00983-3864
Country	:	US
Telephone Number	:	787-762-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	2TR510 VIA ADELINA
Second Line	:	VILLA FONTANA
City	:	CAROLINA
State	:	PR
Zip	:	00983-3864
Country	:	US
Telephone Number	:	787-762-0045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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