Provider Demographics
NPI:1285743815
Name:MIRANDA, ROBERT ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 LA GONDA WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1741
Mailing Address - Country:US
Mailing Address - Phone:925-552-0490
Mailing Address - Fax:925-552-0493
Practice Address - Street 1:520 LA GONDA WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1741
Practice Address - Country:US
Practice Address - Phone:925-552-0490
Practice Address - Fax:925-552-0493
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA271771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics