Jerry Ervin Miracle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7308 Issued in NC

Practice address

1329 Patterson St
Monroe, NC 28112-4349

Phone

(704) 289-1993

Fax

(704) 226-1743

NPI assigned

Dec 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Miracle Dental Center PA

  • General Practice Dentistry
  • Monroe, NC
  • NPI 1376673632
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306908165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 PATTERSON ST",
            "address_2": "PO BOX 949",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124349",
            "telephone_number": "704-289-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 PATTERSON ST",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281124349",
            "telephone_number": "704-289-1993",
            "fax_number": "704-226-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRACLE",
        "first_name": "JERRY",
        "middle_name": "ERVIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mind and Motion Wellness Center PLLC
• Mindcraft ABA LLC
• Emma Minnich
• Jason B Minsky, D.C.
• Miracle Dental Center PA
• Cawetha Annette Mitchell, LCSW-A
• Kamari Demond Mitchell, MD
• Megan Mitchell
• Khalil Mjahed, DDS
• Arianna Moazzami

• General Practice Dentistry in Monroe, NC
• Providers in Monroe, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.