Provider Demographics
NPI:1366655235
Name:MIRANDA, NOEL SANTOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:SANTOS
Last Name: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 1:1486 HUNTINGTON AVENUE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SO SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5971
Mailing Address - Country:US
Mailing Address - Phone:650-583-8822
Mailing Address - Fax:650-583-7940
Practice Address - Street 1:1486 HUNTINGTON AVENUE
Practice Address - Street 2:SUITE 302
Practice Address - City:SO SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5971
Practice Address - Country:US
Practice Address - Phone:650-583-8822
Practice Address - Fax:650-583-7940
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA520109OtherDENTICAL
CAB4128304OtherDELTA OF CA STATE GOVERNM