Healthcare Provider Details

I. General information

NPI: 1073751889
Provider Name (Legal Business Name): CLAUDIO L MIRO DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 SW 42ND AVE FL 2
CORAL GABLES FL
33134-1962
US

IV. Provider business mailing address

564 SW 42ND AVE FL 2
CORAL GABLES FL
33134-1962
US

V. Phone/Fax

Practice location:
  • Phone: 305-442-7444
  • Fax:
Mailing address:
  • Phone: 305-442-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 16862
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN11650
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN16786
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIO L MIRO
Title or Position: PRESIDENT
Credential: DDS
Phone: 305-442-7444