MEDICARE: DR. CATHERINE JOANNA MYRICK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4199	SC

General Provider Information

NPI Number	:	1609897107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE JOANNA MYRICK D.M.D.

Provider Business Mailing Address
First Line	:	179 AUTUMN FALLS DR
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-9239
Country	:	US
Telephone Number	:	803-222-4518
Fax Number	:	803-222-4598

Provider Business Practice Location Address
First Line	:	203 CHURCH ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1008
Country	:	US
Telephone Number	:	803-222-4518
Fax Number	:	803-222-4598

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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