Provider Demographics
NPI:1023036365
Name:MIRANDA, PABLO ENRIQUE II (DMD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:ENRIQUE
Last Name:MIRANDA
Suffix:II
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 1:445 GRAND BAY DRIVE
Mailing Address - Street 2:210
Mailing Address - City:KEYBISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149
Mailing Address - Country:US
Mailing Address - Phone:305-856-2300
Mailing Address - Fax:305-325-0935
Practice Address - Street 1:1050 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2105
Practice Address - Country:US
Practice Address - Phone:305-856-2300
Practice Address - Fax:305-856-0921
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist