Provider Demographics
NPI:1467578179
Name:MIRANDA, ALVIN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:CHRISTOPHER
Last Name:MIRANDA
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 1:720 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-1500
Mailing Address - Country:US
Mailing Address - Phone:410-420-9705
Mailing Address - Fax:
Practice Address - Street 1:200 THOMAS ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-420-9705
Practice Address - Fax:410-420-9708
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist