Provider Demographics
NPI:1457505950
Name:EDWIN M. MYERS, D.D.S., P.C.
Entity Type:Organization
Organization Name:EDWIN M. MYERS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-796-9366
Mailing Address - Street 1:18110 E US HIGHWAY 24
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-1170
Mailing Address - Country:US
Mailing Address - Phone:816-796-9366
Mailing Address - Fax:816-796-9797
Practice Address - Street 1:18110 E US HIGHWAY 24
Practice Address - Street 2:STE. A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-1170
Practice Address - Country:US
Practice Address - Phone:816-796-9366
Practice Address - Fax:816-796-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13974261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS031943OtherBLUE CROSS BLUE SHIELD
MO10150018OtherBLUE CROSS BLUE SHIELD PROVIDER ID#
MO483652OtherUNITED CONCORDIA