Provider Demographics
NPI:1043330913
Name:STUART G MERLE & ALAN R ZICHERMAN PC
Entity Type:Organization
Organization Name:STUART G MERLE & ALAN R ZICHERMAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ZICHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-535-2500
Mailing Address - Street 1:1 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2200
Mailing Address - Country:US
Mailing Address - Phone:978-535-2500
Mailing Address - Fax:978-535-6327
Practice Address - Street 1:1 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2200
Practice Address - Country:US
Practice Address - Phone:978-535-2500
Practice Address - Fax:978-535-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210421223G0001X
MA128001223P0221X
MA127831223P0221X
MA207951223P0221X
MA199841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty