Provider Demographics
NPI:1043232218
Name:DR CHARLES D. MYERS, JR DMD
Entity Type:Organization
Organization Name:DR CHARLES D. MYERS, JR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-567-3175
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-0760
Mailing Address - Country:US
Mailing Address - Phone:843-567-3175
Mailing Address - Fax:843-567-3293
Practice Address - Street 1:133 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:ST STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479
Practice Address - Country:US
Practice Address - Phone:843-567-3175
Practice Address - Fax:843-567-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC1954OtherSC LICENSE NUMBER
SC919542Medicaid
SCSC1954OtherSC LICENSE NUMBER