Provider Demographics
NPI:1366679839
Name:THOMAS P MYATT DDS LTD
Entity Type:Organization
Organization Name:THOMAS P MYATT DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-329-2299
Mailing Address - Street 1:757 W 7TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3672
Mailing Address - Country:US
Mailing Address - Phone:775-329-2299
Mailing Address - Fax:775-329-2450
Practice Address - Street 1:757 W 7TH ST STE 102
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3672
Practice Address - Country:US
Practice Address - Phone:775-329-2299
Practice Address - Fax:775-329-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002100931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT75479Medicare PIN