Provider Demographics
NPI:1982622692
Name:MYERS, CHARLES D JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:MYERS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:SAINT STEPHEN
Mailing Address - State:SC
Mailing Address - Zip Code:29479-0760
Mailing Address - Country:US
Mailing Address - Phone:843-567-3176
Mailing Address - Fax:843-567-3292
Practice Address - Street 1:133 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ST STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479
Practice Address - Country:US
Practice Address - Phone:843-567-3175
Practice Address - Fax:843-567-3293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC919542Medicaid