Healthcare Provider Details

I. General information

NPI: 1962356758
Provider Name (Legal Business Name): DR. MIRANDA DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N56W14044 SILVER SPRING DR STE 101
MENOMONEE FALLS WI
53051-5931
US

IV. Provider business mailing address

N56W14044 SILVER SPRING DR STE 101
MENOMONEE FALLS WI
53051-5931
US

V. Phone/Fax

Practice location:
  • Phone: 262-373-1850
  • Fax:
Mailing address:
  • Phone: 262-373-1850
  • Fax: 262-373-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA PETER
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 262-373-1850