Provider Demographics
NPI:1548418411
Name:MIERISCH, SANDRA VIOLETA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:VIOLETA
Last Name:MIERISCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11336 SW 184 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177
Mailing Address - Country:US
Mailing Address - Phone:305-251-4262
Mailing Address - Fax:
Practice Address - Street 1:11336 SW 184 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177
Practice Address - Country:US
Practice Address - Phone:305-251-4262
Practice Address - Fax:786-242-6351
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD.N.12179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist