Provider Demographics
NPI:1972623353
Name:MYERS, RONNIE (DDS)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
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 1:630 W 168TH ST
Mailing Address - Street 2:COLUMBIA UNIVERSITY COLLEGE OF DENTAL M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-5199
Mailing Address - Fax:212-305-2964
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:COLUMBIA UNIVERSITY COLLEGE OF DENTAL M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:212-305-5199
Practice Address - Fax:212-305-2964
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0345381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice