Healthcare Provider Details

I. General information

NPI: 1447269212
Provider Name (Legal Business Name): DANIEL P MYERS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1301 STATE ROAD 13 W
NORTH MANCHESTER IN
46962-9100
US

IV. Provider business mailing address

202 W 2ND ST
NORTH MANCHESTER IN
46962-1537
US

V. Phone/Fax

Practice location:
  • Phone: 260-982-6042
  • Fax:
Mailing address:
  • Phone: 260-982-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010752A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: