Provider Demographics
NPI:1902238496
Name:MIRANDA, LUIS FELIPE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FELIPE
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-1938
Mailing Address - Country:US
Mailing Address - Phone:270-365-7244
Mailing Address - Fax:
Practice Address - Street 1:406 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445
Practice Address - Country:US
Practice Address - Phone:270-365-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist