Provider Demographics
NPI:1639526643
Name:MIRANDA, ESTEFANIA ISABEL (DMD)
Entity Type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:ISABEL
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 RODNEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9106
Mailing Address - Country:US
Mailing Address - Phone:717-764-8541
Mailing Address - Fax:717-767-5946
Practice Address - Street 1:1623 RODNEY RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9106
Practice Address - Country:US
Practice Address - Phone:717-764-8541
Practice Address - Fax:717-767-5946
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist