Provider Demographics
NPI:1194191619
Name:ALVIN C. MIRANDA, D.D.S, P.A.
Entity type:Organization
Organization Name:ALVIN C. MIRANDA, D.D.S, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-420-9705
Mailing Address - Street 1:200 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3634
Mailing Address - Country:US
Mailing Address - Phone:410-420-9705
Mailing Address - Fax:
Practice Address - Street 1:200 THOMAS ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3634
Practice Address - Country:US
Practice Address - Phone:410-420-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13020122300000X
MD15773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty