Provider Demographics
NPI:1912045451
Name:MIRANDA-RAMIREZ, FERNANDO R (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:R
Last Name:MIRANDA-RAMIREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CALLE KINGS CT
Mailing Address - Street 2:APT. 7A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1119
Mailing Address - Country:US
Mailing Address - Phone:787-736-6886
Mailing Address - Fax:787-715-3312
Practice Address - Street 1:157 CALLE MUNOZ RIVERA S
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4209
Practice Address - Country:US
Practice Address - Phone:787-736-6886
Practice Address - Fax:787-715-3312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice