Provider Demographics
NPI:1679453625
Name:WANIS, MIREL (DMD)
Entity type:Individual
Prefix:
First Name:MIREL
Middle Name:
Last Name:WANIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 CHERRY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4023
Mailing Address - Country:US
Mailing Address - Phone:626-224-2783
Mailing Address - Fax:
Practice Address - Street 1:7950 CHERRY AVE STE 105
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4023
Practice Address - Country:US
Practice Address - Phone:626-224-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1120021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice