Provider Demographics
NPI:1013291228
Name:MYERS, BENJAMIN REECE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:REECE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-3858
Mailing Address - Country:US
Mailing Address - Phone:662-289-4781
Mailing Address - Fax:662-289-6143
Practice Address - Street 1:500 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3858
Practice Address - Country:US
Practice Address - Phone:662-289-4781
Practice Address - Fax:662-289-6143
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3623-11122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist