Provider Demographics
NPI:1740224385
Name:MYERS, ROBERT L (DMD, MBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:MYERS
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S 32ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5103
Mailing Address - Country:US
Mailing Address - Phone:717-763-1970
Mailing Address - Fax:717-975-2891
Practice Address - Street 1:207 S 32ND ST STE 100
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5103
Practice Address - Country:US
Practice Address - Phone:717-763-1970
Practice Address - Fax:717-975-2891
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030386L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU73636Medicare UPIN
PA023252Medicare PIN