Provider Demographics
NPI:1689714933
Name:AMIL, MIRIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:AMIL
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:PMB 240 PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-0851
Mailing Address - Country:US
Mailing Address - Phone:787-286-2600
Mailing Address - Fax:787-286-2600
Practice Address - Street 1:RAFAEL CORDERO AVE EDIFCORPORACION SANOS
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-2600
Practice Address - Fax:787-286-2600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1491122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1491OtherSTATE LICENSE