MEDICARE: MYPS LLC

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

General Provider Information

NPI Number	:	1932476561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYPS LLC

Provider Business Mailing Address
First Line	:	3749 LATROBE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1164
Country	:	US
Telephone Number	:	704-365-0006
Fax Number	:	704-365-0007

Provider Business Practice Location Address
First Line	:	3749 LATROBE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1164
Country	:	US
Telephone Number	:	704-365-0006
Fax Number	:	704-365-0007

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY ELIZABETH MIDDLETON
Credential	:
Telephone Number	:	704-365-0006

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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Directions to “MYPS LLC ” Practice Location

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