Provider Demographics
NPI:1104989508
Name:SMITH, MYLA SAWYA (LPN-RDH)
Entity type:Individual
Prefix:MS
First Name:MYLA
Middle Name:SAWYA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN-RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4825
Mailing Address - Country:US
Mailing Address - Phone:914-668-5691
Mailing Address - Fax:
Practice Address - Street 1:683 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4825
Practice Address - Country:US
Practice Address - Phone:914-668-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017211-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist