Provider Demographics
NPI:1902594252
Name:DANCEL-BEAL, MYHLA MARIE LAYUGAN
Entity Type:Individual
Prefix:
First Name:MYHLA MARIE
Middle Name:LAYUGAN
Last Name:DANCEL-BEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-5012
Mailing Address - Country:US
Mailing Address - Phone:360-224-9127
Mailing Address - Fax:
Practice Address - Street 1:2014 HOWARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4532
Practice Address - Country:US
Practice Address - Phone:509-525-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA614389601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice