Provider Demographics
NPI:1568559839
Name:THOMAS H. LAYNE, III, D.D.S. & DAWN M. MYERS, D.D.S.
Entity Type:Organization
Organization Name:THOMAS H. LAYNE, III, D.D.S. & DAWN M. MYERS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-372-5725
Mailing Address - Street 1:P.O. BOX 746
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271
Mailing Address - Country:US
Mailing Address - Phone:304-372-5715
Mailing Address - Fax:304-372-5770
Practice Address - Street 1:119 SOUTH COURT STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271
Practice Address - Country:US
Practice Address - Phone:304-372-5725
Practice Address - Fax:304-372-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006377Medicaid