Dr. Doctor Micah J'King Blaze, DMD
Dentist in Cincinnati, OH. Individual provider (NPI-1).
NPI number1124681069
StatusActive
Last updated in NPPESFeb 10, 2025
Details
- NPI
- 1124681069
- Entity type
- Individual (NPI-1)
- Name
- Dr. Doctor Micah J'King Blaze
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 16, 2019
- Certification date
- Feb 10, 2025
- Last updated
- Feb 10, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 30.026412 | OH | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | |
| 1223G0001X | Dentist, General Practice | 30.026412 | OH |
Other names
- Michael J. Brooks (Former Name)
Practice location
5 E Liberty StCincinnati, OH 45202-8202
Phone 513-721-6060
Mailing address
518 6th StCampbell, OH 44405-1140
Phone 513-805-3894
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