Provider Demographics
NPI:1154937258
Name:MYERS FAMILY DENTAL LLC
Entity type:Organization
Organization Name:MYERS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-201-0347
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84723-0164
Mailing Address - Country:US
Mailing Address - Phone:435-201-0347
Mailing Address - Fax:
Practice Address - Street 1:110 S 100 E
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:UT
Practice Address - Zip Code:84723
Practice Address - Country:US
Practice Address - Phone:435-201-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental