Provider Demographics
NPI:1346805876
Name:MYERS, JODIE POINTER (RDH)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:POINTER
Last Name:MYERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7508
Mailing Address - Country:US
Mailing Address - Phone:229-886-1815
Mailing Address - Fax:
Practice Address - Street 1:10845 TIMBER RD
Practice Address - Street 2:
Practice Address - City:SOUTH PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23805-7508
Practice Address - Country:US
Practice Address - Phone:229-886-1815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402204095124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist