Provider Demographics
NPI:1932375268
Name:MYRACLE ORTHODONTICS LLC
Entity Type:Organization
Organization Name:MYRACLE ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYRACLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-858-0711
Mailing Address - Street 1:8900 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3424
Mailing Address - Country:US
Mailing Address - Phone:812-858-0711
Mailing Address - Fax:
Practice Address - Street 1:8900 RUFFIAN LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3424
Practice Address - Country:US
Practice Address - Phone:812-858-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010421A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty