MEDICARE: OSCAR GUILLERMO MIRANDA RDH

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	124Q00000X	Dental Hygienist	23751	FL

General Provider Information

NPI Number	:	1922462407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSCAR GUILLERMO MIRANDA RDH

Provider Business Mailing Address
First Line	:	5726 HOOD ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3234
Country	:	US
Telephone Number	:	323-826-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	5726 HOOD ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3234
Country	:	US
Telephone Number	:	323-826-4199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/11/2016

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