Mira Mesa Dental & Orthodontic Office

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20326 Issued in CA

Legal business name

MIRA MESA DENTAL & ORTHODONTIC OFFICE

Practice address

9750 Miramar Road
Suite 260
San Diego, CA 92126

Phone

(858) 566-5050

Fax

(858) 566-7414

NPI assigned

Oct 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cynthia A Johnson

Title

Administrator

Phone

(858) 566-5050

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Michael Johnson, DDS

  • Dentist
  • San Diego, CA
  • NPI 1053757120
  NPD (past)
• Tina S Martinez, DDS

  • General Practice Dentistry
  • San Diego, CA
  • NPI 1609212521
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124104336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9750 MIRAMAR ROAD",
            "address_2": "SUITE 260",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92126",
            "telephone_number": "858-566-5050",
            "fax_number": "858-566-7414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9750 MIRAMAR ROAD",
            "address_2": "SUITE 260",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92126",
            "telephone_number": "858-566-5050",
            "fax_number": "858-566-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRA MESA DENTAL & ORTHODONTIC OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "858-566-5050",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "20326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS",
            "identifier": "858859",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua James Minuto, M.D.
• Todd Michael Miodek, NP
• Mikael Mir, MD
• Mira Mesa Business Group LLC
• Mira Mesa Chiropractic
• Mira Mesa Optometry, Inc
• Melanie Mira
• Cynthia Marie Miracle, MD
• Juliet Miracle, BCBA
• Miracor Diagnostics, Inc.

• General Practice Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.