Provider Demographics
NPI:1508875014
Name:MYINT, THET (DDS)
Entity Type:Individual
Prefix:
First Name:THET
Middle Name:
Last Name:MYINT
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 1:6270 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1560
Mailing Address - Country:US
Mailing Address - Phone:626-291-2060
Mailing Address - Fax:626-291-2217
Practice Address - Street 1:6270 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1560
Practice Address - Country:US
Practice Address - Phone:626-291-2060
Practice Address - Fax:626-291-2217
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice