Provider Demographics
NPI:1821285776
Name:MYKLEBY, BRIAN ARTHUR (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:MYKLEBY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E 52ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2786
Mailing Address - Country:US
Mailing Address - Phone:563-441-1781
Mailing Address - Fax:563-441-1784
Practice Address - Street 1:2215 E 52ND ST STE 1
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2786
Practice Address - Country:US
Practice Address - Phone:563-441-1781
Practice Address - Fax:563-441-1784
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist