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General NPI Number Information
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NPI Number | 1669995890
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Entity Type | Individual
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Provider Name | MIRANDA KORE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 72415 PARKVIEW DR
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City | PALM DESERT
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State | CA
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Zip | 92260-2779
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Country | US
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Telephone | 760-568-5928
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Fax |
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Provider Business Mailing Address
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Address Line | 26423 MARGARITA LN
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City | LOMA LINDA
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State | CA
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Zip | 92354-6741
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Country | US
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Telephone | 909-363-5496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 101530
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License Number State | CA
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