Provider Demographics
NPI:1962518829
Name:MYERS, ROGER LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:MYERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 CAPULET DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-4541
Mailing Address - Country:US
Mailing Address - Phone:904-299-2942
Mailing Address - Fax:904-299-2943
Practice Address - Street 1:180 CAPULET DR STE 3
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-4541
Practice Address - Country:US
Practice Address - Phone:904-299-2942
Practice Address - Fax:904-299-2943
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery