Individual
DR. DAVID ELLMAN MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3997 BECKLEY RD, PRINCETON, WV 24740-7660
(304) 431-5499
(304) 431-3400
Mailing address
3997 BECKLEY RD, PRINCETON, WV 24740-7660
(304) 431-5499
(304) 431-3400
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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