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General NPI Number Information
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NPI Number | 1285824482
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Entity Type | Organization
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Legal Business Name | DENNIS T. MYERS D.D.S.,P.A
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 3115 ASHLAND AVE SUIT299
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City | ST JOSEPH
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State | MO
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Zip | 64506
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Country | US
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Telephone | 816-232-9790
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Fax | 816-232-9814
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Provider Business Mailing Address
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Address Line | 3115 ASHLAND AVE SUIT299
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City | ST JOSEPH
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State | MO
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Zip | 64506
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Country | US
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Telephone | 816-232-9790
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Fax | 816-232-9814
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM KAY MANTHE
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Credential |
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Telephone | 816-232-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 011475
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License Number State | MO
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