Provider Demographics
NPI:1295846335
Name:MIRANDA, REGINA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:C
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 1:6115 S HULEN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133
Mailing Address - Country:US
Mailing Address - Phone:817-263-9014
Mailing Address - Fax:817-263-7081
Practice Address - Street 1:6115 S HULEN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133
Practice Address - Country:US
Practice Address - Phone:817-263-9014
Practice Address - Fax:817-263-7081
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist