Provider Demographics
NPI:1861547176
Name:MYERS, FREDERICK JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN
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 1:8135 SOULE RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1578
Mailing Address - Country:US
Mailing Address - Phone:315-622-2523
Mailing Address - Fax:315-622-0594
Practice Address - Street 1:8135 SOULE RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1578
Practice Address - Country:US
Practice Address - Phone:315-622-2523
Practice Address - Fax:315-622-0594
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist