Provider Demographics
NPI:1376564872
Name:MYRICK, ERNEST LLOYD JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LLOYD
Last Name:MYRICK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 GRASMERE LN
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8676
Mailing Address - Country:US
Mailing Address - Phone:803-222-4518
Mailing Address - Fax:803-222-4598
Practice Address - Street 1:203 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1008
Practice Address - Country:US
Practice Address - Phone:803-222-4518
Practice Address - Fax:803-222-4598
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice