Active NPI
Roxana Mirabal, D.M.D
- Dentist
- Fairbanks, AK
National Provider Identifier
1528299948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DNO13951
- Practice address
- 1717 West Cowles St.
Fairbanks, AK 99701-5926 - Phone
- (706) 255-2879
- NPI assigned
- Aug 3, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DNO13951 | GA | Primary |
Addresses
Primary practice location
1717 West Cowles St.
Fairbanks, AK 99701-5926
Mailing address
1717 W. Cowles St.
Fairbanks, AK 99701-5926
Phone (907) 452-8251
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160609000685 | AK | Order and Referring Only - Other (Physician) | 2466742077 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO13951 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360800000000",
"number": "1528299948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 W. COWLES ST.",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "907-452-8251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 WEST COWLES ST.",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015926",
"telephone_number": "706-255-2879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRABAL",
"first_name": "ROXANA",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-03",
"last_updated": "2013-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DNO13951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.