Provider Demographics
NPI:1417024118
Name:MIRO, CLAUDIO L (DDS)
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:L
Last Name:MIRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 SW 42ND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1962
Mailing Address - Country:US
Mailing Address - Phone:305-442-7444
Mailing Address - Fax:305-445-7771
Practice Address - Street 1:564 SW 42ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1962
Practice Address - Country:US
Practice Address - Phone:305-442-7444
Practice Address - Fax:305-445-7771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071953600Medicaid