Provider Demographics
NPI:1508005190
Name:COVARRUBIAS, MYRA I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:I
Last Name:COVARRUBIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W. DICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037
Mailing Address - Country:US
Mailing Address - Phone:269-962-1536
Mailing Address - Fax:269-962-1950
Practice Address - Street 1:3003 W. DICKMAN RD.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037
Practice Address - Country:US
Practice Address - Phone:269-962-1536
Practice Address - Fax:269-962-1950
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice