Provider Demographics
NPI:1629179031
Name:STEPHEN C MYERS, DMD, PA
Entity Type:Organization
Organization Name:STEPHEN C MYERS, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-234-7080
Mailing Address - Street 1:10510 HUTCHISON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407
Mailing Address - Country:US
Mailing Address - Phone:850-234-7080
Mailing Address - Fax:850-236-0249
Practice Address - Street 1:10510 HUTCHISON BOULEVARD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-234-7080
Practice Address - Fax:850-236-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAM9710078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty