=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992689517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRANDA FABREGA DMD MS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9633 LEVIN RD NW STE 206
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-7998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-692-3030
-----------------------------------------------------
Fax | 360-692-7720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9633 LEVIN RD NW STE 206
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-7998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-692-3030
-----------------------------------------------------
Fax | 360-692-7720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ORTHODONTIST
-----------------------------------------------------
Name | DR. MIRANDA FABREGA
-----------------------------------------------------
Credential | DMD MS
-----------------------------------------------------
Telephone | 360-908-0004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------