Provider Demographics
NPI:1700603271
Name:J. A. MIRELEZ JR DDS INC.
Entity type:Organization
Organization Name:J. A. MIRELEZ JR DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-977-6565
Mailing Address - Street 1:145 N CLOVIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0361
Mailing Address - Country:US
Mailing Address - Phone:559-314-1310
Mailing Address - Fax:559-314-1311
Practice Address - Street 1:145 N CLOVIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0361
Practice Address - Country:US
Practice Address - Phone:559-314-1310
Practice Address - Fax:559-314-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty