MEDICARE: THERESE SINGSON MIRANDA DDS 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
1	122300000X	Dentist	25501	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447570510	OTHER	TX	NPI TYPE 1-INDIVIDUAL

General Provider Information

NPI Number	:	1447528278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESE SINGSON MIRANDA DDS PC

Provider Business Mailing Address
First Line	:	5975 FM 78
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1003
Country	:	US
Telephone Number	:	210-661-4211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5975 FM 78
Second Line	:	SUITE 100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1003
Country	:	US
Telephone Number	:	210-661-4211
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. LOU ANN ZERGER
Credential	:
Telephone Number	:	210-661-4211

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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