Provider Demographics
NPI:1083916134
Name:MYERS, WILLIAM DANE (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20491 THE GRANADA
Mailing Address - Street 2:UNIT 11
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432
Mailing Address - Country:US
Mailing Address - Phone:352-489-6610
Mailing Address - Fax:352-465-1471
Practice Address - Street 1:20491 THE GRANADA
Practice Address - Street 2:UNIT 11
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432
Practice Address - Country:US
Practice Address - Phone:352-489-6610
Practice Address - Fax:352-465-1471
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL140830242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist