MEDICARE: BANYAS AND MIRANDA, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1134348626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANYAS AND MIRANDA, D.D.S.

Provider Business Mailing Address
First Line	:	216 W WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5624
Country	:	US
Telephone Number	:	423-928-0265
Fax Number	:	423-928-0265

Provider Business Practice Location Address
First Line	:	216 W WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5624
Country	:	US
Telephone Number	:	423-928-0265
Fax Number	:	423-928-0265

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DAVID J MIRANDA
Credential	:	D.D.S.
Telephone Number	:	423-928-0265

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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