MEDICARE: DR. CRAIG A. MYRMEL D.D.S.

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	122300000X	Dentist	3044	AZ

General Provider Information

NPI Number	:	1831310978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A. MYRMEL D.D.S.

Provider Business Mailing Address
First Line	:	1701 E THOMAS RD
Second Line	:	STE 204
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7675
Country	:	US
Telephone Number	:	602-253-6600
Fax Number	:	602-733-6480

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD
Second Line	:	SUITE 15
City	:	MESA
State	:	AZ
Zip	:	85213-4213
Country	:	US
Telephone Number	:	480-807-2636
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/10/2016

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