Gary R Myers, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN14903 Issued in FL

Practice address

3200 Old Jennings Road
Middleburg, FL 32068-3414

Phone

(904) 505-2010

Fax

(904) 505-2011

NPI assigned

Aug 1, 2006

Last updated

Jul 12, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 10, 2017 through Jan 10, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Myers Pediatric Dentistry PA

  • Pediatric Dentistry
  • Middleburg, FL
  • NPI 1982619425
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1639186182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 OLD JENNINGS ROAD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683414",
            "telephone_number": "904-505-2010",
            "fax_number": "904-505-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 OLD JENNINGS ROAD",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320683414",
            "telephone_number": "904-505-2010",
            "fax_number": "904-505-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "GARY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN14903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1768502",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "85410",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yusuf A Mosuro, MD
• Terry D Mundorff Sr., RPH
• Kasey K Murray, DPT
• Myers Pediatric Dentistry PA
• Donnie A Myers, DDS
• Michael Edward Myers, LMT
• Myeyedr. Optometry of Florida, LLC (MyEyeDr.)
• N.E.F. Community Achievement Network, Inc
• Kimberly Layne Nall, ARNP
• Natalia Fieber Therapy, LLC

• Pediatric Dentistry in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.