Provider Demographics
NPI:1487772315
Name:MYERS, DELMONT G (DMD)
Entity type:Individual
Prefix:DR
First Name:DELMONT
Middle Name:G
Last Name:MYERS
Suffix:
Gender:M
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:PO BOX 1486
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1486
Mailing Address - Country:US
Mailing Address - Phone:435-438-5940
Mailing Address - Fax:435-438-5918
Practice Address - Street 1:885 NO, 50 E.
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713
Practice Address - Country:US
Practice Address - Phone:435-438-5940
Practice Address - Fax:435-438-5918
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT265200-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice