1982162657 NPI number — SANDRA MIRANDA DENTAL HYGIENIST

Table of content: SANDRA MIRANDA DENTAL HYGIENIST (NPI 1982162657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982162657 NPI number — SANDRA MIRANDA DENTAL HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982162657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2621 S 3270 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST VALLEY CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84119-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
385-261-2737
Provider Business Mailing Address Fax Number:
17-460-4208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1388 S NAVAJO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84104-3493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
19-552-3608
Provider Business Practice Location Address Fax Number:
801-746-0420
Provider Enumeration Date:
03/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  6781179-0701 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com