Provider Demographics
NPI:1245698554
Name:MYERS, ANITA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:C TONKING
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:134 MENGER SPGS
Mailing Address - Street 2:#1310
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7218
Mailing Address - Country:US
Mailing Address - Phone:830-816-5160
Mailing Address - Fax:830-282-6794
Practice Address - Street 1:134 MENGER SPGS
Practice Address - Street 2:#1310
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7218
Practice Address - Country:US
Practice Address - Phone:830-816-5160
Practice Address - Fax:830-282-6794
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist