Provider Demographics
NPI:1770592693
Name:MIRELES, DAVID R (DDS,MS,INC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MIRELES
Suffix:
Gender:M
Credentials:DDS,MS,INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 E SOUTHCROSS
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222
Mailing Address - Country:US
Mailing Address - Phone:210-333-1020
Mailing Address - Fax:210-333-4142
Practice Address - Street 1:4025 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:210-333-1020
Practice Address - Fax:210-333-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics