Healthcare Provider Details

I. General information

NPI: 1861535775
Provider Name (Legal Business Name): MYLES O EADY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MAIN STREET EXT
WALLINGFORD CT
06492-2400
US

IV. Provider business mailing address

850 N MAIN STREET EXT
WALLINGFORD CT
06492-2400
US

V. Phone/Fax

Practice location:
  • Phone: 203-949-1701
  • Fax: 203-284-9547
Mailing address:
  • Phone: 203-949-1701
  • Fax: 203-284-9547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7294
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7294
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: