Provider Demographics
NPI:1508202979
Name:SMITH & MYERS ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:SMITH & MYERS ORTHODONTICS PLLC
Other - Org Name:BEAUR R. MYERS, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-687-6560
Mailing Address - Street 1:5315 FOUNTAIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-3094
Mailing Address - Country:US
Mailing Address - Phone:865-657-6560
Mailing Address - Fax:
Practice Address - Street 1:5315 FOUNTAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-3094
Practice Address - Country:US
Practice Address - Phone:865-657-6560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN85401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty