| NPI | 1376673632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY E MIRACLE Dentist 704-289-1993 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7308) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |