Healthcare Provider Details

I. General information

NPI: 1831884436
Provider Name (Legal Business Name): MIRANDA LYNN WEBER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA LYNN ANDERSON DDS

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 W PRAIRIE AVE
POST FALLS ID
83854
US

IV. Provider business mailing address

2004 W DOMAINE CT
COEUR D ALENE ID
83815-1001
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-0292
  • Fax:
Mailing address:
  • Phone: 208-818-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-5521
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61604888
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: