Provider Demographics
NPI:1336866011
Name:SHERPA, MIRIAM GRISEL (DDS)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:GRISEL
Last Name:SHERPA
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 1:24570 STEWART ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2726
Mailing Address - Country:US
Mailing Address - Phone:760-718-7203
Mailing Address - Fax:
Practice Address - Street 1:24570 STEWART ST APT 10
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2726
Practice Address - Country:US
Practice Address - Phone:760-718-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist