| Robert L Miracle, Dmd, Pc | |
|
1810 Nw Ferris Ave Lawton OK 73507-5625 | |
| (580) 355-1314 | |
| (580) 355-1027 |
| Full Name | Robert L Miracle, Dmd, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1810 Nw Ferris Ave, Lawton, Oklahoma |
| Authorized Official Name and Position | Robert Miracle (PRESIDENT) |
| Authorized Official Contact | 5803551314 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert L Miracle, Dmd, Pc 1810 Nw Ferris Ave Lawton OK 73507-5625 Ph: (580) 355-1314 | Robert L Miracle, Dmd, Pc 1810 Nw Ferris Ave Lawton OK 73507-5625 Ph: (580) 355-1314 |
| NPI Number | 1053635615 |
|---|---|
| Provider Enumeration Date | 03/25/2010 |
| Last Update Date | 03/25/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053635615 | NPI | - | NPPES |
| 100124580B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4 5347 (Oklahoma) | Primary |
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