Healthcare Provider Details

I. General information

NPI: 1396003570
Provider Name (Legal Business Name): ERNESTO MIRELES, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E BORONDA RD SUITE B
SALINAS CA
93906-3129
US

IV. Provider business mailing address

608 E BORONDA RD SUITE B
SALINAS CA
93906-3129
US

V. Phone/Fax

Practice location:
  • Phone: 831-443-3524
  • Fax: 831-443-4637
Mailing address:
  • Phone: 831-443-3524
  • Fax: 831-443-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35946
License Number StateCA

VIII. Authorized Official

Name: DR. ERNESTO MIRELES
Title or Position: DOCTOR/OWNER
Credential: DDS
Phone: 831-443-3524