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Individual
DR. DAVID ELLMAN MIRANDA
Active
Individual
DR. DAVID ELLMAN MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
WV3097
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001735593
BCBS
WV
05
—
0133749000
—
WV
Enumeration date
02/04/2009
Last updated
02/14/2014
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