Provider Demographics
NPI:1992961866
Name:LACY, MIRANDA COLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:COLE
Last Name:LACY
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 1:3604 PRESTON RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8629
Mailing Address - Country:US
Mailing Address - Phone:972-312-0000
Mailing Address - Fax:972-312-0600
Practice Address - Street 1:3604 PRESTON RD
Practice Address - Street 2:SUITE #400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8629
Practice Address - Country:US
Practice Address - Phone:972-312-0000
Practice Address - Fax:972-312-0600
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice