Provider Demographics
NPI:1831117407
Name:MYERS, ERIC ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ARTHUR
Last Name:MYERS
Suffix:
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 1:6211 4TH ST NW STE 13
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5762
Mailing Address - Country:US
Mailing Address - Phone:505-821-5437
Mailing Address - Fax:
Practice Address - Street 1:6211 4TH ST NW STE 13
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5762
Practice Address - Country:US
Practice Address - Phone:505-821-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD25131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57459568Medicaid
NM1768244OtherUNITED CONCORDIA GROUP #