Provider Demographics
NPI:1124109392
Name:DOMONEY, MYRNA BYERS (DDS)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:BYERS
Last Name:DOMONEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 S EUCALYPTUS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5940
Mailing Address - Country:US
Mailing Address - Phone:918-250-0624
Mailing Address - Fax:918-250-9437
Practice Address - Street 1:1621 S EUCALYPTUS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5940
Practice Address - Country:US
Practice Address - Phone:918-250-0624
Practice Address - Fax:918-250-9437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice