Provider Demographics
NPI:1831186956
Name:MYATT, THOMAS P (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:MYATT
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 1:757 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3672
Mailing Address - Country:US
Mailing Address - Phone:775-329-2299
Mailing Address - Fax:775-329-2450
Practice Address - Street 1:757 W 7TH ST
Practice Address - Street 2:102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3604
Practice Address - Country:US
Practice Address - Phone:775-329-2299
Practice Address - Fax:775-329-2450
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002100931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT75479Medicare UPIN