Provider Demographics
NPI:1649273608
Name:MYERS, WILLIAM T (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
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 1:1616 13TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3840
Mailing Address - Country:US
Mailing Address - Phone:304-691-1247
Mailing Address - Fax:304-691-1248
Practice Address - Street 1:1616 13TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3840
Practice Address - Country:US
Practice Address - Phone:304-691-1247
Practice Address - Fax:304-691-1248
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 2028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV2028OtherWV LICENSE NUMBER
WV000588343OtherUNITED CONCORDIA ID NUMBE
WV0135759000Medicaid
WV000588343OtherUNITED CONCORDIA ID NUMBE
WVWV2028OtherWV LICENSE NUMBER