Provider Demographics
NPI:1245343516
Name:GAY, MYRA SOTELO (DDS)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:SOTELO
Last Name:GAY
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 1:420 E FM 2410 RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5717
Mailing Address - Country:US
Mailing Address - Phone:254-699-3359
Mailing Address - Fax:254-699-0597
Practice Address - Street 1:420 E FM 2410 RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5717
Practice Address - Country:US
Practice Address - Phone:254-699-3359
Practice Address - Fax:254-699-0597
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104057819OtherNPI