Provider Demographics
NPI:1164646725
Name:WILLIAM A. MYERS II DMD LTD
Entity Type:Organization
Organization Name:WILLIAM A. MYERS II DMD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:304-599-2415
Mailing Address - Street 1:1191 PINEVIEW DR STE D
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2778
Mailing Address - Country:US
Mailing Address - Phone:304-599-2415
Mailing Address - Fax:
Practice Address - Street 1:1191 PINEVIEW DR STE D
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2778
Practice Address - Country:US
Practice Address - Phone:304-599-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0138091000Medicaid