Healthcare Provider Details

I. General information

NPI: 1699791608
Provider Name (Legal Business Name): THOMAS F MYERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 STATE STREET
NEW ALBANY IN
47150
US

IV. Provider business mailing address

1801 STATE STREET
NEW ALBANY IN
47150
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-2198
  • Fax: 812-944-0836
Mailing address:
  • Phone: 812-945-2198
  • Fax: 812-944-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6735
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: