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General NPI Number Information
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NPI Number | 1194191619
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Entity Type | Organization
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Legal Business Name | ALVIN C. MIRANDA, D.D.S, P.A.
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 200 THOMAS ST
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City | BEL AIR
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State | MD
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Zip | 21014-3634
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Country | US
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Telephone | 410-420-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 200 THOMAS ST
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City | BEL AIR
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State | MD
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Zip | 21014-3634
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Country | US
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Telephone | 410-420-9705
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALVIN CHRISTOPHER MIRANDA
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Credential | DDS
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Telephone | 410-420-9705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 15773
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13020
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License Number State | MD
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