# ROBERT L MIRACLE, DMD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053635615
- **Authorized official:** DR. ROBERT MIRACLE DMD (PRESIDENT)
- **Authorized official phone:** (580) 355-1314

## Contact information

- **Practice address:** 1810 NW FERRIS AVE, LAWTON, OK 73507-5625
- **Practice address phone:** (580) 355-1314
- **Practice address fax:** (580) 355-1027
- **Mailing address:** 1810 NW FERRIS AVE, LAWTON, OK 73507-5625
- **Mailing address phone:** (580) 355-1314
- **Mailing address fax:** (580) 355-1027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 4 5347 | OK | Yes |

## Other

- **Enumeration date:** 03/25/2010
- **Last updated:** 03/25/2010