Individual
CARLOS J MIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
821 S 57TH ST, WEST ALLIS, WI 53214-3333
(414) 302-9468
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4641-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33725700
—
WI
Enumeration date
11/15/2005
Last updated
04/05/2021
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