Provider Demographics
NPI:1659753267
Name:JOSE F. MIRANDA D.D.S., INC.
Entity Type:Organization
Organization Name:JOSE F. MIRANDA D.D.S., INC.
Other - Org Name:SMILE SAVVY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:FERDINAND
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-393-3180
Mailing Address - Street 1:14676 PIPELINE AVE STE R
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1918
Mailing Address - Country:US
Mailing Address - Phone:909-393-3180
Mailing Address - Fax:909-393-0372
Practice Address - Street 1:14676 PIPELINE AVE STE R
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1918
Practice Address - Country:US
Practice Address - Phone:909-393-3180
Practice Address - Fax:909-393-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty