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General NPI Number Information
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NPI Number | 1932375268
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Entity Type | Organization
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Legal Business Name | MYRACLE ORTHODONTICS LLC
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 8900 RUFFIAN LN
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City | NEWBURGH
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State | IN
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Zip | 47630-3424
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Country | US
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Telephone | 812-858-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 8900 RUFFIAN LN
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City | NEWBURGH
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State | IN
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Zip | 47630-3424
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Country | US
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Telephone | 812-858-0711
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. GEORGE M. MYRACLE
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Credential | D.D.S.
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Telephone | 812-858-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12010421A
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License Number State | IN
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