Active NPI
George M. Myracle, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Sikeston, MO
National Provider Identifier
1861668196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 13502
- Practice address
- 411 Tanner St
Sikeston, MO 63801-4272 - Phone
- (573) 471-2077
- NPI assigned
- May 6, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 13502 | MO | Primary |
Addresses
Primary practice location
411 Tanner St
Sikeston, MO 63801-4272
Mailing address
411 Tanner St
Sikeston, MO 63801-4272
Phone (573) 471-2077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13502 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1861668196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 TANNER ST",
"city": "SIKESTON",
"state": "MO",
"postal_code": "638014272",
"telephone_number": "573-471-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 TANNER ST",
"city": "SIKESTON",
"state": "MO",
"postal_code": "638014272",
"telephone_number": "573-471-2077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYRACLE",
"first_name": "GEORGE",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-06",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "13502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.