Healthcare Provider Details

I. General information

NPI: 1992689517
Provider Name (Legal Business Name): MIRANDA FABREGA DMD MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
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 Number
License Number State

VIII. Authorized Official

Name: DR. MIRANDA FABREGA
Title or Position: OWNER/ORTHODONTIST
Credential: DMD MS
Phone: 360-908-0004