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NPI Code Detail

MEDICARE: MIRANDA DENTAL PC

MEDICARE: MIRANDA DENTAL PC
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
11223G0001XGeneral Practice Dentistry25501TX

General Provider Information

NPI Number : 1134541501
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRANDA DENTAL PC
Provider Business Mailing Address
First Line : 5983 BANDERA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78238-1822
Country : US
Telephone Number : 210-681-4867
Fax Number :
Provider Business Practice Location Address
First Line : 5983 BANDERA RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78238-1822
Country : US
Telephone Number : 210-681-4867
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. THERESE SINGSON MIRANDA
Credential : DDS
Telephone Number : 210-681-4867
Provider Enumeration Date : 01/20/2014
Last Update Date : 01/20/2014

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Directions to “MIRANDA DENTAL PC ” Practice Location

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