Provider Demographics
NPI:1932320660
Name:MYERS, ROBERTA
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8249 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4601
Mailing Address - Country:US
Mailing Address - Phone:623-979-8800
Mailing Address - Fax:623-979-6940
Practice Address - Street 1:8249 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4601
Practice Address - Country:US
Practice Address - Phone:623-979-8800
Practice Address - Fax:623-979-6940
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist