Provider Demographics
NPI:1760565659
Name:MYERS, RICHARD III (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:MYERS
Suffix:III
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 1:801 W OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-2747
Mailing Address - Country:US
Mailing Address - Phone:865-522-1244
Mailing Address - Fax:865-525-7041
Practice Address - Street 1:801 W OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-2747
Practice Address - Country:US
Practice Address - Phone:865-522-1244
Practice Address - Fax:865-525-7041
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS30551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225283Medicaid