Provider Demographics
NPI:1922352269
Name:MASSEY, MYRON LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:LLOYD
Last Name:MASSEY
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 1:322 N H ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3224
Mailing Address - Country:US
Mailing Address - Phone:909-709-5657
Mailing Address - Fax:
Practice Address - Street 1:322 N H ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3224
Practice Address - Country:US
Practice Address - Phone:909-709-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist