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General NPI Number Information
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NPI Number | 1982619425
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Entity Type | Organization
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Legal Business Name | MYERS PEDIATRIC DENTISTRY PA
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 3200 OLD JENNINGS RD
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3414
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Country | US
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Telephone | 904-505-2010
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Fax | 904-505-2011
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Provider Business Mailing Address
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Address Line | 3200 OLD JENNINGS RD
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City | MIDDLEBURG
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State | FL
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Zip | 32068-3414
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Country | US
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Telephone | 904-505-2010
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Fax | 904-505-2011
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY MYERS
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Credential | DMD
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Telephone | 904-505-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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