Provider Demographics
NPI:1538237953
Name:MIRANDA, JOSE FS (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FS
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 1:14676 PIPELINE AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1918
Mailing Address - Country:US
Mailing Address - Phone:909-393-3180
Mailing Address - Fax:909-393-0372
Practice Address - Street 1:14676 PIPELINE AVE.
Practice Address - Street 2:STE. Q
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1909
Practice Address - Country:US
Practice Address - Phone:909-393-3180
Practice Address - Fax:909-393-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice