Provider Demographics
NPI:1861822900
Name:MIRANDA, ANJALI T (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:T
Last Name:MIRANDA
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 1:959 BRUSH HOLLOW ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-333-1552
Mailing Address - Fax:
Practice Address - Street 1:959 BRUSH HOLLOW ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-333-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist