1568559839 NPI number — THOMAS H. LAYNE, III, D.D.S. & DAWN M. MYERS, D.D.S.

Table of content: (NPI 1568559839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568559839 NPI number — THOMAS H. LAYNE, III, D.D.S. & DAWN M. MYERS, D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS H. LAYNE, III, D.D.S. & DAWN M. MYERS, D.D.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568559839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 746
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIPLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-372-5715
Provider Business Mailing Address Fax Number:
304-372-5770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 SOUTH COURT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-372-5725
Provider Business Practice Location Address Fax Number:
304-372-5770
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAYNE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
HARVEY
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
304-372-5725

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2479 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810006377 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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