Individual
DR. KENNETH LEE MYRACLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
700 BROADWAY AVE E, MATTOON, IL 61938-4671
(217) 235-1101
Mailing address
13 S COUNTRY CLUB RD, MATTOON, IL 61938-9023
(217) 258-8781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
07/04/2007
Last updated
07/08/2007
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