Provider Demographics
NPI:1962497040
Name:MYERS, CARL WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WAYNE
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 1:2317 WHITESBURG DR S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3819
Mailing Address - Country:US
Mailing Address - Phone:256-533-1282
Mailing Address - Fax:256-533-1288
Practice Address - Street 1:2317 WHITESBURG DR S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3819
Practice Address - Country:US
Practice Address - Phone:256-533-1282
Practice Address - Fax:256-533-1288
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51094958OtherBLUECROSS PROVIDER NUMBER
PA00000508686OtherUNITED CONCORDIA PROVIDER
TN0010054OtherBLUECROSS TN PROVIDER NU
AL51094958OtherBLUECROSS PROVIDER NUMBER