Provider Demographics
NPI:1962851634
Name:CLAUDIO L MIRO DDS
Entity Type:Organization
Organization Name:CLAUDIO L MIRO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARBAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-7444
Mailing Address - Street 1:564 SW 42ND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1962
Mailing Address - Country:US
Mailing Address - Phone:305-442-7444
Mailing Address - Fax:305-445-7771
Practice Address - Street 1:564 SW 42ND AVE FL 2
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1962
Practice Address - Country:US
Practice Address - Phone:305-442-7444
Practice Address - Fax:305-445-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014663700Medicaid