Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | F-25446 | TX |
N | 1223P0221X | Pediatric Dentist | F-25446 | TX |
NPI | 1669757670 |
---|---|
Provider Name | Dr. Malathi Shirley Miranda |
First Address | Dallas, TX 75246-2013 |
Second Address | Dallas, TX 75246-2013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2011 |
Last Update Date | 21/10/2011 |