Provider Demographics
NPI:1780741389
Name:MYERS, GARY D (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
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 1:6803 MAYFIELD RD STE 209
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2212
Mailing Address - Country:US
Mailing Address - Phone:440-461-7347
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD STE 209
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2212
Practice Address - Country:US
Practice Address - Phone:440-461-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00137221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice