Provider Demographics
NPI:1427250992
Name:MIRELES, ERNESTO (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:MIRELES
Suffix:
Gender:M
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:PO BOX 2477
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927
Mailing Address - Country:US
Mailing Address - Phone:831-674-5501
Mailing Address - Fax:831-443-4637
Practice Address - Street 1:696 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927
Practice Address - Country:US
Practice Address - Phone:831-674-5501
Practice Address - Fax:831-674-0462
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist