Provider Demographics
NPI:1144880808
Name:FERRARI, MIRANDA JO (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:JO
Last Name:FERRARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CREEKSTONE RDG
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8986
Mailing Address - Country:US
Mailing Address - Phone:304-677-1308
Mailing Address - Fax:
Practice Address - Street 1:3 CREEKSTONE RDG
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8986
Practice Address - Country:US
Practice Address - Phone:304-677-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice