Provider Demographics
NPI:1114027174
Name:MIRANDA, LINA M (DDS)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:M
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:
Other - Last Name:MIRANDA RENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2742 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3200
Mailing Address - Country:US
Mailing Address - Phone:305-559-8518
Mailing Address - Fax:305-480-8465
Practice Address - Street 1:2742 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3200
Practice Address - Country:US
Practice Address - Phone:305-559-8518
Practice Address - Fax:305-480-8465
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00100051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice