Healthcare Provider Details

I. General information

NPI: 1558023838
Provider Name (Legal Business Name): MIRANDA FABREGA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 LEVIN RD NW STE 206
SILVERDALE WA
98383-7998
US

IV. Provider business mailing address

9633 LEVIN RD NW STE 206
SILVERDALE WA
98383-7998
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-3030
  • Fax: 360-692-7720
Mailing address:
  • Phone: 360-692-3030
  • Fax: 360-692-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61247888
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: