Provider Demographics
NPI:1609390582
Name:MYRON L MASSEY DDS INC
Entity Type:Organization
Organization Name:MYRON L MASSEY DDS INC
Other - Org Name:DENTAL PRACTICE OF SAN BERNARDINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-709-5657
Mailing Address - Street 1:322 N H ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3224
Mailing Address - Country:US
Mailing Address - Phone:909-888-1301
Mailing Address - Fax:909-884-4697
Practice Address - Street 1:322 N H ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3224
Practice Address - Country:US
Practice Address - Phone:909-888-1301
Practice Address - Fax:909-884-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61417261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental