Organization
ROBERT L MIRACLE, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT MIRACLE DMD (PRESIDENT)
(580) 355-1314
Entity
Organization
Contact information
Practice address
1810 NW FERRIS AVE, LAWTON, OK 73507-5625
(580) 355-1314
(580) 355-1027
Mailing address
1810 NW FERRIS AVE, LAWTON, OK 73507-5625
(580) 355-1314
(580) 355-1027
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4 5347
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100124580B
—
OK
Enumeration date
03/25/2010
Last updated
03/25/2010
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