Healthcare Provider Details

I. General information

NPI: 1881522191
Provider Name (Legal Business Name): MIRACLES DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE STE 210
ORANGE CA
92868-3929
US

IV. Provider business mailing address

19262 JASPER HILL RD
TRABUCO CANYON CA
92679-1174
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-6666
  • Fax:
Mailing address:
  • Phone: 949-981-2121
  • Fax: 714-660-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER BISHAY
Title or Position: CEO
Credential: DMD
Phone: 714-639-6666