Provider Demographics
NPI:1043221757
Name:MIRANDA, NORMA ASSUNCION (DDS)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:ASSUNCION
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 TERMINO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2121
Mailing Address - Country:US
Mailing Address - Phone:562-494-8400
Mailing Address - Fax:562-494-8412
Practice Address - Street 1:1729 TERMINO AVE
Practice Address - Street 2:1363 S OLIVE ST LOS ANGELES CA 90015
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2121
Practice Address - Country:US
Practice Address - Phone:562-494-8400
Practice Address - Fax:562-494-8412
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93855-01Medicaid
CAB2575901Medicaid