MEDICARE: MRS. KENDRA LEE MYERS RDH

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	124Q00000X	Dental Hygienist	02619	NH

General Provider Information

NPI Number	:	1962567040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDRA LEE MYERS RDH

Provider Business Mailing Address
First Line	:	5 EVERGREEN DR
Second Line	:
City	:	MERRIMACK
State	:	NH
Zip	:	03054-3273
Country	:	US
Telephone Number	:	603-429-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 STATE ROUTE 101A
Second Line	:
City	:	AMHERST
State	:	NH
Zip	:	03031-2274
Country	:	US
Telephone Number	:	603-672-6546
Fax Number	:

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/08/2007

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