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Individual

DR. MALCOLM BAKER MIRACLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
7607 DIXIE HWY, FLORENCE, KY 41042-2644
(859) 655-6100
Mailing address
1401 MADISON AVE, COVINGTON, KY 41011-3313
(859) 655-6100
(859) 655-6148

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6261
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
60062619
KY
01
62610
DELTA DENTAL
KY
01
E973
ANTHEM BCBS
KY
Enumeration date
12/28/2006
Last updated
05/04/2020
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