Provider Demographics
NPI:1790150118
Name:MYERS, PAMELA JANE (RDH)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:MYERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 12TH STREET HUI
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77349-0001
Mailing Address - Country:US
Mailing Address - Phone:936-437-1676
Mailing Address - Fax:
Practice Address - Street 1:815 12TH STREET HUI
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77349
Practice Address - Country:US
Practice Address - Phone:936-437-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist