Provider Demographics
NPI:1780114025
Name:MYERS, SKYLER EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:SKYLER
Middle Name:EDWARD
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 1:214 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4211
Mailing Address - Country:US
Mailing Address - Phone:601-616-5158
Mailing Address - Fax:
Practice Address - Street 1:302 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3630
Practice Address - Country:US
Practice Address - Phone:662-834-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3927-17122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist