Provider Demographics
NPI:1073751889
Name:CLAUDIO L MIRO DDS
Entity Type:Organization
Organization Name:CLAUDIO L MIRO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-442-7444
Mailing Address - Street 1:564 SW 42ND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1962
Mailing Address - Country:US
Mailing Address - Phone:305-442-7444
Mailing Address - Fax:
Practice Address - Street 1:564 SW 42ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1962
Practice Address - Country:US
Practice Address - Phone:305-442-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16862122300000X
FLDN116501223G0001X
FLDN167861223G0001X
124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071953600Medicaid