Provider Demographics
NPI:1780711499
Name:MIRANDA, CRISTIAN (DDS)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-326-7257
Mailing Address - Fax:650-321-1227
Practice Address - Street 1:652 HOMER AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-326-7257
Practice Address - Fax:650-321-1227
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice