Provider Demographics
NPI:1780112607
Name:MIRANDA, NICOL (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOL
Middle Name:
Last Name:MIRANDA
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 1:8100 NW 53RD ST APT 352
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4850
Mailing Address - Country:US
Mailing Address - Phone:786-683-1442
Mailing Address - Fax:
Practice Address - Street 1:14252 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3100
Practice Address - Country:US
Practice Address - Phone:305-553-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist