Healthcare Provider Details

I. General information

NPI: 1578602116
Provider Name (Legal Business Name): DANIEL M MEYERS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SAINT MICHAELS DR SUITE A
SANTA FE NM
87505-7604
US

IV. Provider business mailing address

550 SAINT MICHAELS DR SUITE A
SANTA FE NM
87505-7604
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8605
  • Fax: 505-983-5441
Mailing address:
  • Phone: 505-983-8605
  • Fax: 505-983-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDD2440
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: