MEDICARE: DR. ALDO L MIRANDA-COLLAZO 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	1469	PR

General Provider Information

NPI Number	:	1811994072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALDO L MIRANDA-COLLAZO DMD

Provider Business Mailing Address
First Line	:	249 CALLE LAS MARIAS
Second Line	:	HYDE PARK
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4224
Country	:	US
Telephone Number	:	787-751-5090
Fax Number	:	787-751-5090

Provider Business Practice Location Address
First Line	:	249 CALLE LAS MARIAS
Second Line	:	HYDE PARK
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4224
Country	:	US
Telephone Number	:	787-751-5090
Fax Number	:	787-751-5090

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

Provider Enumeration Date	:	07/02/2005
Last Update Date	:	01/31/2013

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