Provider Demographics
NPI:1669995890
Name:KORE, MIRANDA (DDS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:KORE
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 1:26423 MARGARITA LN
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6741
Mailing Address - Country:US
Mailing Address - Phone:909-363-5496
Mailing Address - Fax:
Practice Address - Street 1:72415 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2779
Practice Address - Country:US
Practice Address - Phone:760-568-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist