Individual
DR. JERRY ERVIN MIRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1329 PATTERSON ST, MONROE, NC 28112-4349
(704) 289-1993
(704) 226-1743
Mailing address
1329 PATTERSON ST, PO BOX 949, MONROE, NC 28112-4349
(704) 289-1993
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7308
NC
Other
Enumeration date
12/15/2006
Last updated
07/08/2007
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