Provider Demographics
NPI:1477642825
Name:MYERS, THOMAS RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RUSSELL
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 1:101 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-3751
Mailing Address - Country:US
Mailing Address - Phone:865-457-3211
Mailing Address - Fax:865-457-8018
Practice Address - Street 1:101 MARKET PL
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3751
Practice Address - Country:US
Practice Address - Phone:865-457-3211
Practice Address - Fax:865-457-8018
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice