Provider Demographics
NPI:1750639357
Name:LINA M MIRANDA DDS,PA
Entity Type:Organization
Organization Name:LINA M MIRANDA DDS,PA
Other - Org Name:SUNSET DENTAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-275-0500
Mailing Address - Street 1:9210 SW 72 ST
Mailing Address - Street 2:103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-275-0500
Mailing Address - Fax:305-275-0503
Practice Address - Street 1:9210 SW 72 ST
Practice Address - Street 2:103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-275-0500
Practice Address - Fax:305-275-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0010005261QD0000X
FLDN19261261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental