Provider Demographics
NPI:1063599793
Name:MYERS, DAN WALKER (DMD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:WALKER
Last Name:MYERS
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8077
Mailing Address - Country:US
Mailing Address - Phone:770-833-4161
Mailing Address - Fax:
Practice Address - Street 1:113 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8077
Practice Address - Country:US
Practice Address - Phone:770-833-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO12029122300000X
SC9813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582628995OtherTAX ID #