Provider Demographics
NPI:1548952740
Name:COUCHE, MIRANDA (RDH)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:COUCHE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20189 HUMMINGBIRD HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:CA
Mailing Address - Zip Code:95713-9628
Mailing Address - Country:US
Mailing Address - Phone:916-517-2099
Mailing Address - Fax:
Practice Address - Street 1:20601 PAOLI LN
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-9629
Practice Address - Country:US
Practice Address - Phone:530-637-4025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32245124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist