Provider Demographics
NPI:1619721701
Name:MIRACLES DENTAL
Entity Type:Organization
Organization Name:MIRACLES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-639-6666
Mailing Address - Street 1:805 W LA VETA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3929
Mailing Address - Country:US
Mailing Address - Phone:714-639-6666
Mailing Address - Fax:
Practice Address - Street 1:805 W LA VETA AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3929
Practice Address - Country:US
Practice Address - Phone:714-639-6666
Practice Address - Fax:714-660-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental