Provider Demographics
NPI:1154440261
Name:MEYERKOVA, KIRA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KIRA
Middle Name:
Last Name:MEYERKOVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1951
Mailing Address - Country:US
Mailing Address - Phone:818-352-8888
Mailing Address - Fax:818-352-4457
Practice Address - Street 1:8522 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1951
Practice Address - Country:US
Practice Address - Phone:818-352-8888
Practice Address - Fax:818-352-4457
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD41958-01Medicaid