Provider Demographics
NPI:1336364959
Name:MIRABAL, GERMAN OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:OMAR
Last Name:MIRABAL
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:B13 CALLE POPPY
Mailing Address - Street 2:URB PARQUE FORESTAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6340
Mailing Address - Country:US
Mailing Address - Phone:787-317-4258
Mailing Address - Fax:
Practice Address - Street 1:2D24 AVENIDA PINO
Practice Address - Street 2:URB VILLA DEL REY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice