Provider Demographics
NPI:1467465732
Name:MYERS, MARK ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:MYERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BOGART RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-2303
Mailing Address - Country:US
Mailing Address - Phone:419-433-2751
Mailing Address - Fax:
Practice Address - Street 1:107 BOGART RD
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-2303
Practice Address - Country:US
Practice Address - Phone:419-433-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice