Provider Demographics
NPI:1619265758
Name:MIRANDA ALOS, JEAN PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:JEAN PAUL
Middle Name:
Last Name:MIRANDA ALOS
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 1:1511 AVE PONCE DE LEON APT 10144
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-5001
Mailing Address - Country:US
Mailing Address - Phone:787-646-4473
Mailing Address - Fax:
Practice Address - Street 1:A20 CII PARKSIDE 2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-201-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33031223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics