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 |