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Individual

DR. GERARD MATTHEW MIRKOV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
89 PARK STREET, MONTCLAIR, NJ 07042
(973) 746-6200
(973) 744-3114
Mailing address
89 PARK STREET, MONTCLAIR, NJ 07042
(973) 746-6200
(973) 744-3114

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17326
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5619904
NJ
Enumeration date
04/16/2007
Last updated
07/08/2007
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