Provider Demographics
NPI:1578093241
Name:MYER, LACEY (DMD)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:MYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 WENTWORTH ST APT E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1279
Mailing Address - Country:US
Mailing Address - Phone:843-588-0044
Mailing Address - Fax:
Practice Address - Street 1:116 EAST ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:FOLLY BEACH
Practice Address - State:SC
Practice Address - Zip Code:29439
Practice Address - Country:US
Practice Address - Phone:843-588-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18576421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice