Provider Demographics
NPI:1861535775
Name:EADY, MYLES O (DDS)
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:O
Last Name:EADY
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 1:850 N MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-949-1701
Mailing Address - Fax:203-284-9547
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-949-1701
Practice Address - Fax:203-284-9547
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72941223P0300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics