Provider Demographics
NPI:1285824482
Name:DENNIS T. MYERS D.D.S.,P.A
Entity Type:Organization
Organization Name:DENNIS T. MYERS D.D.S.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MANTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-9790
Mailing Address - Street 1:3115 ASHLAND AVE SUIT299
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-9790
Mailing Address - Fax:816-232-9814
Practice Address - Street 1:3115 ASHLAND AVE SUIT299
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-9790
Practice Address - Fax:816-232-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS860976OtherBCBS OF KS