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General NPI Number Information
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NPI Number | 1184788507
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Entity Type | Organization
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Legal Business Name | MARK D. MEYERS DDS, PC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 11678 BAPTIST CHURCH RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1382
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Country | US
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Telephone | 314-849-1400
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Fax | 314-849-7644
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Provider Business Mailing Address
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Address Line | 11678 BAPTIST CHURCH RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-1382
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Country | US
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Telephone |
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Fax | 314-849-7644
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK D. MEYERS DDS
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Credential | D.D.S.
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Telephone | 314-849-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 013134
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License Number State | MO
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