Provider Demographics
NPI:1265006555
Name:DIAZ MIRANDA, ORLANDO JASIEL (DMD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:JASIEL
Last Name:DIAZ MIRANDA
Suffix:
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:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0638
Mailing Address - Country:US
Mailing Address - Phone:718-823-5500
Mailing Address - Fax:787-823-2990
Practice Address - Street 1:106 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3002
Practice Address - Country:US
Practice Address - Phone:787-252-5500
Practice Address - Fax:787-252-5509
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist