Healthcare Provider Details

I. General information

NPI: 1093633166
Provider Name (Legal Business Name): MYERS ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MYERS RD STE A
SUMMERVILLE SC
29486-8819
US

IV. Provider business mailing address

216 MYERS RD STE A
SUMMERVILLE SC
29486-8819
US

V. Phone/Fax

Practice location:
  • Phone: 843-261-2001
  • Fax: 843-738-6942
Mailing address:
  • Phone: 843-261-2001
  • Fax: 843-738-6942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNI TOMLINSON
Title or Position: CREDENTIALING AND ENROLLMENT
Credential:
Phone: 470-552-1823