Provider Demographics
NPI:1932476561
Name:MYPS LLC
Entity Type:Organization
Organization Name:MYPS LLC
Other - Org Name:MY DENTISTS LATROBE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-365-0006
Mailing Address - Street 1:3749 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1164
Mailing Address - Country:US
Mailing Address - Phone:704-365-0006
Mailing Address - Fax:704-365-0007
Practice Address - Street 1:3749 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1164
Practice Address - Country:US
Practice Address - Phone:704-365-0006
Practice Address - Fax:704-365-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty