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General NPI Number Information
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NPI Number | 1972623353
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Entity Type | Individual
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Provider Name | RONNIE MYERS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 630 W 168TH ST COLUMBIA UNIVERSITY COLLEGE OF DENTAL M
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City | NEW YORK
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State | NY
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Zip | 10032-3725
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Country | US
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Telephone | 212-305-5199
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Fax | 212-305-2964
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Provider Business Mailing Address
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Address Line | 630 W 168TH ST COLUMBIA UNIVERSITY COLLEGE OF DENTAL M
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City | NEW YORK
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State | NY
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Zip | 10032-3725
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Country | US
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Telephone | 212-305-5199
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Fax | 212-305-2964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 034538
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License Number State | NY
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