Individual
DR. DOCTOR MICAH J'KING BLAZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5 E LIBERTY ST, CINCINNATI, OH 45202-8202
(513) 721-6060
Mailing address
518 6TH ST, CAMPBELL, OH 44405-1140
(513) 805-3894
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.026412
OH
1223G0001X
General Practice Dentistry
30.026412
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2019
Last updated
02/10/2025
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