Provider Demographics
NPI:1881748986
Name:MYERS, RONALD (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
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 1:2537 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3413
Mailing Address - Country:US
Mailing Address - Phone:718-786-2631
Mailing Address - Fax:718-956-8425
Practice Address - Street 1:2537 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3413
Practice Address - Country:US
Practice Address - Phone:718-786-2631
Practice Address - Fax:718-956-8425
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04021211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01045436Medicaid