Provider Demographics
NPI:1780602078
Name:MYERS, KENNETH K (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
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 1:225 EAGLE CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648
Mailing Address - Country:US
Mailing Address - Phone:970-675-2389
Mailing Address - Fax:970-675-2344
Practice Address - Street 1:225 EAGLE CREST DRIVE
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648
Practice Address - Country:US
Practice Address - Phone:970-675-2389
Practice Address - Fax:970-675-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice