Provider Demographics
NPI:1215148374
Name:MYERS, KEVIN WADE (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WADE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 ERRINGER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2235
Mailing Address - Country:US
Mailing Address - Phone:805-583-5589
Mailing Address - Fax:
Practice Address - Street 1:2345 ERRINGER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2235
Practice Address - Country:US
Practice Address - Phone:805-583-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice