Provider Demographics
NPI:1447528278
Name:THERESE SINGSON MIRANDA DDS PC
Entity type:Organization
Organization Name:THERESE SINGSON MIRANDA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOU
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-661-4211
Mailing Address - Street 1:5975 FM 78
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1003
Mailing Address - Country:US
Mailing Address - Phone:210-661-4211
Mailing Address - Fax:
Practice Address - Street 1:5975 FM 78
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1003
Practice Address - Country:US
Practice Address - Phone:210-661-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447570510OtherNPI TYPE 1-INDIVIDUAL