Provider Demographics
NPI:1295023166
Name:MYERS, ANDREA M (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:MYERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2858
Mailing Address - Country:US
Mailing Address - Phone:937-390-0493
Mailing Address - Fax:
Practice Address - Street 1:2200 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2858
Practice Address - Country:US
Practice Address - Phone:937-390-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011694A122300000X
OH300239091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084707Medicaid