Provider Demographics
NPI:1396003570
Name:ERNESTO MIRELES, DDS
Entity Type:Organization
Organization Name:ERNESTO MIRELES, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRELES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-443-3524
Mailing Address - Street 1:608 E BORONDA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3129
Mailing Address - Country:US
Mailing Address - Phone:831-443-3524
Mailing Address - Fax:831-443-4637
Practice Address - Street 1:608 E BORONDA RD
Practice Address - Street 2:SUITE B
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3129
Practice Address - Country:US
Practice Address - Phone:831-443-3524
Practice Address - Fax:831-443-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty