Provider Demographics
NPI:1326108895
Name:MIYAMOTO, MIRYAM SUSANA (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRYAM
Middle Name:SUSANA
Last Name:MIYAMOTO
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Gender:F
Credentials:MD, DDS
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Mailing Address - Street 1:23333 CINEMA DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5432
Mailing Address - Country:US
Mailing Address - Phone:661-254-6464
Mailing Address - Fax:661-254-8367
Practice Address - Street 1:23333 CINEMA DR
Practice Address - Street 2:SUITE #200
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5432
Practice Address - Country:US
Practice Address - Phone:661-254-6464
Practice Address - Fax:661-254-8367
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA371411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics