Provider Demographics
NPI:1922371509
Name:ROSALINDA MIRANDA-MAURICIO DDS A DENTAL CORP
Entity Type:Organization
Organization Name:ROSALINDA MIRANDA-MAURICIO DDS A DENTAL CORP
Other - Org Name:NORTHWEST DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:MIRANDA
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-674-0927
Mailing Address - Street 1:2531 HOWARD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5040
Mailing Address - Country:US
Mailing Address - Phone:559-674-0927
Mailing Address - Fax:559-674-0595
Practice Address - Street 1:2531 HOWARD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5040
Practice Address - Country:US
Practice Address - Phone:559-674-0927
Practice Address - Fax:559-674-0595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9310001OtherDENTICAL
CA1922371509OtherNPI