Individual
DR. MIRANDA ALBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7131 S JEFFERY BLVD STE A, CHICAGO, IL 60649
(773) 256-0526
Mailing address
1137 W WEBSTER AVE # 2, CHICAGO, IL 60614-3529
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026464
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376000511-60680-08
—
IL
Enumeration date
11/06/2006
Last updated
07/08/2007
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