Provider Demographics
NPI:1952520314
Name:VLAD, MIRUNA DINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRUNA
Middle Name:DINA
Last Name:VLAD
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 1:18253 CHELMSFORD DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-6402
Mailing Address - Country:US
Mailing Address - Phone:408-255-2171
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE
Practice Address - Street 2:SUITE # 8-C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5013
Practice Address - Country:US
Practice Address - Phone:408-255-0410
Practice Address - Fax:408-973-0979
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist