Provider Demographics
NPI:1649391368
Name:MIRABAL, BEATRIZ (DDS)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:MIRABAL
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 1:615 S HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2404
Mailing Address - Country:US
Mailing Address - Phone:215-906-0865
Mailing Address - Fax:
Practice Address - Street 1:720 YORKLYN RD
Practice Address - Street 2:STE 120
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8728
Practice Address - Country:US
Practice Address - Phone:302-234-2728
Practice Address - Fax:302-234-3326
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice