Provider Demographics
NPI:1912992207
Name:MYERS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MYERS FAMILY DENTISTRY
Other - Org Name:JAMES R MYERS JR DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-848-8520
Mailing Address - Street 1:211 WASHINGTON HEIGHTS MED CTR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5632
Mailing Address - Country:US
Mailing Address - Phone:410-848-8520
Mailing Address - Fax:410-848-8667
Practice Address - Street 1:211 WASHINGTON HEIGHTS MED CTR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5632
Practice Address - Country:US
Practice Address - Phone:410-848-8520
Practice Address - Fax:410-848-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5013261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental