Individual
JEFFREY MIRRIELEES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
808 WAPPOO RD, CHARLESTON, SC 29407-5865
(843) 818-5437
Mailing address
808 WAPPOO RD, CHARLESTON, SC 29407-5865
(843) 818-5437
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8680
SC
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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