Provider Demographics
NPI:1073511416
Name:MERRILL, ROBERT SHERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHERMAN
Last Name:MERRILL
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 1:112 S STONE ST
Mailing Address - Street 2:P.O. BOX 25
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722-7221
Mailing Address - Country:US
Mailing Address - Phone:715-286-2960
Mailing Address - Fax:
Practice Address - Street 1:112 S STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-7221
Practice Address - Country:US
Practice Address - Phone:715-286-2960
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2537-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33416700Medicaid